Provider Demographics
NPI:1780687012
Name:BURN, KATHLEEN MALM (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MALM
Last Name:BURN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 CHESAPEAKE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-6716
Mailing Address - Country:US
Mailing Address - Phone:865-691-3110
Mailing Address - Fax:865-691-3110
Practice Address - Street 1:913 CHESAPEAKE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-6716
Practice Address - Country:US
Practice Address - Phone:865-691-3110
Practice Address - Fax:865-691-3110
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001131133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3241480Medicare ID - Type UnspecifiedREGISTERED DIETITIAN