Provider Demographics
NPI:1790292977
Name:BURTON, KATI A (MS, RDN)
Entity Type:Individual
Prefix:
First Name:KATI
Middle Name:A
Last Name:BURTON
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 SHERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2302
Mailing Address - Country:US
Mailing Address - Phone:406-282-4127
Mailing Address - Fax:
Practice Address - Street 1:1330 SHERWOOD ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2302
Practice Address - Country:US
Practice Address - Phone:406-282-4127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-NUTR-LIC-45718133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered