Provider Demographics
NPI:1376377135
Name:BROADWAY, KATHLEEN CHRISTINE
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:CHRISTINE
Last Name:BROADWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5826 ESPLANADE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4198
Mailing Address - Country:US
Mailing Address - Phone:361-500-2898
Mailing Address - Fax:
Practice Address - Street 1:5826 ESPLANADE DR STE 102
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4198
Practice Address - Country:US
Practice Address - Phone:361-500-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education