Provider Demographics
NPI:1578103339
Name:EDENS, KATELYN CREWS (LDRD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:CREWS
Last Name:EDENS
Suffix:
Gender:F
Credentials:LDRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 GRANDVIEW PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3404
Mailing Address - Country:US
Mailing Address - Phone:205-595-8985
Mailing Address - Fax:205-595-0971
Practice Address - Street 1:3686 GRANDVIEW PKWY STE 400
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3404
Practice Address - Country:US
Practice Address - Phone:205-595-8985
Practice Address - Fax:205-595-0971
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8469836133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered