Provider Demographics
NPI:1245073444
Name:PELFREY, KATHERINE MACKENZIE (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MACKENZIE
Last Name:PELFREY
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1903
Mailing Address - Country:US
Mailing Address - Phone:937-405-5065
Mailing Address - Fax:
Practice Address - Street 1:4337 UNION RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5211
Practice Address - Country:US
Practice Address - Phone:937-405-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86434441133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered