Provider Demographics
NPI:1902359458
Name:MAXEY, KATHERINE BOLES (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:BOLES
Last Name:MAXEY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:BOLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-713-8676
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST BAPTIST HEALTH
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-8676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003169133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered