Provider Demographics
NPI:1902177942
Name:HALL, KATHERINE ELIZABETH (RD LD)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:HALL
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 SOUTHWEST PKWY APT 222
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6242
Mailing Address - Country:US
Mailing Address - Phone:210-862-4105
Mailing Address - Fax:
Practice Address - Street 1:5604 SOUTHWEST PKWY APT 222
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6242
Practice Address - Country:US
Practice Address - Phone:210-862-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT 81700133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered