Provider Demographics
NPI:1295195451
Name:FANN, KATHERINE (MS, RD, LD, CSWOMCDE)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:FANN
Suffix:
Gender:F
Credentials:MS, RD, LD, CSWOMCDE
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1315 SAN JACINTO CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3703
Mailing Address - Country:US
Mailing Address - Phone:303-717-2972
Mailing Address - Fax:
Practice Address - Street 1:841 MANITOU DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1229
Practice Address - Country:US
Practice Address - Phone:303-717-2972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012024505133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered