Provider Demographics
NPI:1639814387
Name:WHETSTONE-KELLEY, KATHRYN DEBORAH (RD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DEBORAH
Last Name:WHETSTONE-KELLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 W PINTA CT
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8340
Mailing Address - Country:US
Mailing Address - Phone:562-743-2780
Mailing Address - Fax:
Practice Address - Street 1:5510 W PINTA CT
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8340
Practice Address - Country:US
Practice Address - Phone:562-743-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID86035808133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered