Provider Demographics
NPI:1568993079
Name:MCINTYRE, KATHY MARIE
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:MARIE
Last Name:MCINTYRE
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 1:6911 TAYLOR RANCH RD NW
Mailing Address - Street 2:SUITE C8
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2963
Mailing Address - Country:US
Mailing Address - Phone:505-433-2674
Mailing Address - Fax:
Practice Address - Street 1:6911 TAYLOR RANCH RD NW
Practice Address - Street 2:SUITE C8
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2963
Practice Address - Country:US
Practice Address - Phone:505-433-2674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-26
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No174H00000XOther Service ProvidersHealth Educator