Provider Demographics
NPI:1184908584
Name:MILLER, KATIE (RD)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:WITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:7731 BLUE HERON CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-2840
Mailing Address - Country:US
Mailing Address - Phone:662-801-4671
Mailing Address - Fax:
Practice Address - Street 1:7731 BLUE HERON CT
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-2840
Practice Address - Country:US
Practice Address - Phone:662-801-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003629133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered