Provider Demographics
NPI:1871023754
Name:DOBIS, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DOBIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:DOBIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CNS
Mailing Address - Street 1:8100 WACOBEE DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-5227
Mailing Address - Country:US
Mailing Address - Phone:843-957-9482
Mailing Address - Fax:
Practice Address - Street 1:3881 RENEE DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4110
Practice Address - Country:US
Practice Address - Phone:843-957-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education