Provider Demographics
NPI:1720603160
Name:BIRKETT, KATHLEEN A (RDN, LD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:BIRKETT
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 NAVIGATORS PT
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-6962
Mailing Address - Country:US
Mailing Address - Phone:864-985-3231
Mailing Address - Fax:
Practice Address - Street 1:714 NAVIGATORS PT
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-6962
Practice Address - Country:US
Practice Address - Phone:864-985-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC61133V00000X
GA000953133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered