Provider Demographics
NPI:1336534825
Name:FISCHER, KATIE BETH (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:BETH
Last Name:FISCHER
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 DRIFTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759-6514
Mailing Address - Country:US
Mailing Address - Phone:719-534-3337
Mailing Address - Fax:
Practice Address - Street 1:126 DRIFTWOOD LN
Practice Address - Street 2:
Practice Address - City:MILLS RIVER
Practice Address - State:NC
Practice Address - Zip Code:28759-6514
Practice Address - Country:US
Practice Address - Phone:719-534-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004571133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered