Provider Demographics
NPI:1518183235
Name:CATES, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 LAKEVIEW DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1532
Mailing Address - Country:US
Mailing Address - Phone:806-468-9400
Mailing Address - Fax:806-468-9401
Practice Address - Street 1:2400 LAKEVIEW DR
Practice Address - Street 2:SUITE 102
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1532
Practice Address - Country:US
Practice Address - Phone:806-468-9400
Practice Address - Fax:806-468-9401
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX596466133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered