Provider Demographics
NPI:1275173320
Name:BROWN, KATHRYN MICHELLE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MICHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 COLEHURST CRES
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5221
Mailing Address - Country:US
Mailing Address - Phone:636-744-3991
Mailing Address - Fax:
Practice Address - Street 1:739 CHAPPELL DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3215
Practice Address - Country:US
Practice Address - Phone:919-832-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005860133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered