Provider Demographics
NPI:1609561497
Name:HORRELL, KATHERINE MARIE (MS, RDN, CPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:HORRELL
Suffix:
Gender:F
Credentials:MS, RDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5948 LONE PEAK DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-5532
Mailing Address - Country:US
Mailing Address - Phone:618-447-4602
Mailing Address - Fax:
Practice Address - Street 1:5948 LONE PEAK DR UNIT A
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-5532
Practice Address - Country:US
Practice Address - Phone:618-447-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic