Provider Demographics
NPI:1811539653
Name:COLLINS, KATHERINE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-5306
Mailing Address - Country:US
Mailing Address - Phone:817-319-7453
Mailing Address - Fax:
Practice Address - Street 1:203 CHRISTIE DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-5549
Practice Address - Country:US
Practice Address - Phone:936-699-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85283133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered