Provider Demographics
NPI:1922379551
Name:LOPEZ, KATHLEEN B (RDN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:B
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:B
Other - Last Name:STANDAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:310 RELIANCE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1737
Mailing Address - Country:US
Mailing Address - Phone:303-908-6210
Mailing Address - Fax:
Practice Address - Street 1:530 W WAMSLEY AVE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IA
Practice Address - Zip Code:50619-7941
Practice Address - Country:US
Practice Address - Phone:303-908-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic