Provider Demographics
NPI:1457127524
Name:BATES, KATHY LEE (RD,LD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LEE
Last Name:BATES
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:LEE
Other - Last Name:PLATTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:22 CORBON CT
Mailing Address - Street 2:
Mailing Address - City:PINE ISLAND
Mailing Address - State:MN
Mailing Address - Zip Code:55963-7626
Mailing Address - Country:US
Mailing Address - Phone:507-251-9442
Mailing Address - Fax:
Practice Address - Street 1:22 CORBON CT
Practice Address - Street 2:
Practice Address - City:PINE ISLAND
Practice Address - State:MN
Practice Address - Zip Code:55963-7626
Practice Address - Country:US
Practice Address - Phone:507-251-9442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4925133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered