Provider Demographics
NPI:1326357757
Name:BERNARD, KATHERINE LISA (RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LISA
Last Name:BERNARD
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MAGNOLIA TREE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6731
Mailing Address - Country:US
Mailing Address - Phone:516-380-9935
Mailing Address - Fax:
Practice Address - Street 1:137 E BUTLER ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3566
Practice Address - Country:US
Practice Address - Phone:516-380-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0026411133V00000X
SC1315133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered