Provider Demographics
NPI:1558142570
Name:GARRISON, KATHY DAWN (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:DAWN
Last Name:GARRISON
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SAINT ANDRE ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2240
Mailing Address - Country:US
Mailing Address - Phone:614-582-7181
Mailing Address - Fax:
Practice Address - Street 1:103 SAINT ANDRE ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2240
Practice Address - Country:US
Practice Address - Phone:614-582-7181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5966133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered