Provider Demographics
NPI:1922764331
Name:KEIRSEY, KATHERINE (RD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KEIRSEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CLAY ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-2117
Mailing Address - Country:US
Mailing Address - Phone:678-378-0190
Mailing Address - Fax:
Practice Address - Street 1:44 CLAY ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-2117
Practice Address - Country:US
Practice Address - Phone:678-378-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered