Provider Demographics
NPI:1902042633
Name:CROTTS, KATHY JONES (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JONES
Last Name:CROTTS
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 TOM CROTTS LN
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-5444
Mailing Address - Country:US
Mailing Address - Phone:336-817-8991
Mailing Address - Fax:
Practice Address - Street 1:125 TOM CROTTS LN
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-5444
Practice Address - Country:US
Practice Address - Phone:336-998-7364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003069133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered