Provider Demographics
NPI:1841428158
Name:SIMONS, KATHRYN WHITFIELD (MED, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:WHITFIELD
Last Name:SIMONS
Suffix:
Gender:F
Credentials:MED, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 HILLHAVEN TER
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-4620
Mailing Address - Country:US
Mailing Address - Phone:336-504-3989
Mailing Address - Fax:
Practice Address - Street 1:636 HILLHAVEN TER
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4620
Practice Address - Country:US
Practice Address - Phone:336-504-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000595133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered