Provider Demographics
NPI:1235804162
Name:SWANN, KATHERINE (RD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SWANN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 COX ST
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-1545
Mailing Address - Country:US
Mailing Address - Phone:512-939-9654
Mailing Address - Fax:
Practice Address - Street 1:107 COX ST
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1545
Practice Address - Country:US
Practice Address - Phone:864-660-3269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLRD.2282RD133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered