Provider Demographics
NPI:1629214788
Name:CRYTSER, KATHLEEN ROGERS (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ROGERS
Last Name:CRYTSER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2247 REEDY FORK RD.
Mailing Address - Street 2:
Mailing Address - City:PELZER
Mailing Address - State:SC
Mailing Address - Zip Code:29669-9286
Mailing Address - Country:US
Mailing Address - Phone:864-243-9443
Mailing Address - Fax:
Practice Address - Street 1:1807A E MAIN ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3841
Practice Address - Country:US
Practice Address - Phone:864-442-7482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC469133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered