Provider Demographics
NPI:1518391598
Name:MAHON, ANNE KEATING (PHD, MS, RD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:KEATING
Last Name:MAHON
Suffix:
Gender:F
Credentials:PHD, MS, RD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARGARET
Other - Last Name:KEATING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7339
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78713-7339
Mailing Address - Country:US
Mailing Address - Phone:512-475-8234
Mailing Address - Fax:512-471-0680
Practice Address - Street 1:100 W DEAN KEETON ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1091
Practice Address - Country:US
Practice Address - Phone:512-475-8234
Practice Address - Fax:512-471-0680
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL833153133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered