Provider Demographics
NPI:1326807165
Name:LANGE, KATIE (RD, LD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19508 SANGREMON WAY
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3463
Mailing Address - Country:US
Mailing Address - Phone:512-609-0651
Mailing Address - Fax:
Practice Address - Street 1:1000 GATTIS SCHOOL RD STE 150B
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2566
Practice Address - Country:US
Practice Address - Phone:512-609-0651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87822133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered