Provider Demographics
NPI:1689083859
Name:KING, KATHY L (RDN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2105
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-2105
Mailing Address - Country:US
Mailing Address - Phone:940-395-3388
Mailing Address - Fax:940-497-2927
Practice Address - Street 1:213 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75065-2721
Practice Address - Country:US
Practice Address - Phone:940-497-3558
Practice Address - Fax:940-497-2927
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT01751133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered