Provider Demographics
NPI:1659550895
Name:RAY, KATHARINE JANE (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:JANE
Last Name:RAY
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 1:224 SPANISH OAK DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2628
Mailing Address - Country:US
Mailing Address - Phone:512-863-9265
Mailing Address - Fax:
Practice Address - Street 1:3613 WILLIAMS DR
Practice Address - Street 2:SUITE 601
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1377
Practice Address - Country:US
Practice Address - Phone:512-863-9265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03008133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered