Provider Demographics
NPI:1346526191
Name:RODGERS, KATHLEEN (MA,RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MA,RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6824 WILD ROSE CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-3124
Mailing Address - Country:US
Mailing Address - Phone:703-866-7864
Mailing Address - Fax:703-866-1382
Practice Address - Street 1:3022 WILLIAMS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4600
Practice Address - Country:US
Practice Address - Phone:703-573-9800
Practice Address - Fax:703-573-2959
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered