Provider Demographics
NPI:1477067189
Name:PEEBLES, KATHERYN MARIE (RD,CDE)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:MARIE
Last Name:PEEBLES
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 PERCIVAL ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-4430
Mailing Address - Country:US
Mailing Address - Phone:804-310-5720
Mailing Address - Fax:804-287-7839
Practice Address - Street 1:12201 PERCIVAL ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-4430
Practice Address - Country:US
Practice Address - Phone:804-310-5720
Practice Address - Fax:804-287-7839
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA46035133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered