Provider Demographics
NPI:1356916027
Name:HAWKS, KATRISHA (RD, CD)
Entity type:Individual
Prefix:
First Name:KATRISHA
Middle Name:
Last Name:HAWKS
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2967 E CANYON CREST DR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-8936
Mailing Address - Country:US
Mailing Address - Phone:801-473-2758
Mailing Address - Fax:
Practice Address - Street 1:2967 E CANYON CREST DR
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-8936
Practice Address - Country:US
Practice Address - Phone:801-473-2758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1035466133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered