Provider Demographics
NPI:1417106493
Name:CALHOUN, KATHERINE DANIELLE (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:DANIELLE
Last Name:CALHOUN
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 1:1013 BRIDGES AVE E
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396
Mailing Address - Country:US
Mailing Address - Phone:870-588-5291
Mailing Address - Fax:866-695-2818
Practice Address - Street 1:1013 BRIDGES AVE EAST
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396
Practice Address - Country:US
Practice Address - Phone:870-588-5291
Practice Address - Fax:866-695-2818
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1013133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered