Provider Demographics
NPI:1881042281
Name:MISENHEIMER, KATHRYN NOEL (MS, RD, LDN, CDCES)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:NOEL
Last Name:MISENHEIMER
Suffix:
Gender:F
Credentials:MS, RD, LDN, CDCES
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:NOEL
Other - Last Name:GRIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN, CDCES
Mailing Address - Street 1:180 OLD BIGHT CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2606
Mailing Address - Country:US
Mailing Address - Phone:704-962-7848
Mailing Address - Fax:
Practice Address - Street 1:185 HARRY S TRUMAN PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7580
Practice Address - Country:US
Practice Address - Phone:410-224-4553
Practice Address - Fax:410-224-8898
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004643133V00000X
MDDX4420133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC261745725OtherAETNA
NC261745725OtherBLUE CROSS AND BLUE SHEILD