Provider Demographics
NPI:1427223437
Name:LONG, KATHRYN R (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:R
Last Name:LONG
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9436
Mailing Address - Country:US
Mailing Address - Phone:814-241-9659
Mailing Address - Fax:
Practice Address - Street 1:1000 S 2ND ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-3318
Practice Address - Country:US
Practice Address - Phone:570-988-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered