Provider Demographics
NPI:1407362163
Name:IRWIN, KATHERINE J (MS, RD, LDN, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:J
Last Name:IRWIN
Suffix:
Gender:F
Credentials:MS, RD, LDN, CNSC
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:J
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, LDN, CNSC
Mailing Address - Street 1:7420 STONINGTON LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-1859
Mailing Address - Country:US
Mailing Address - Phone:865-919-5426
Mailing Address - Fax:
Practice Address - Street 1:990 OAK RIDGE TPKE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6976
Practice Address - Country:US
Practice Address - Phone:865-835-4118
Practice Address - Fax:865-835-4122
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2023133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist