Provider Demographics
NPI:1669120267
Name:WILLEY, KATHERYN ELIZABETH (MS RD LD CDCES)
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:ELIZABETH
Last Name:WILLEY
Suffix:
Gender:F
Credentials:MS RD LD CDCES
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:WILLEY
Other - Last Name:CATHCART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RD LD
Mailing Address - Street 1:3974 LONGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WEST MIDDLESEX
Mailing Address - State:PA
Mailing Address - Zip Code:16159-2912
Mailing Address - Country:US
Mailing Address - Phone:724-977-5527
Mailing Address - Fax:
Practice Address - Street 1:3974 LONGVIEW RD
Practice Address - Street 2:
Practice Address - City:WEST MIDDLESEX
Practice Address - State:PA
Practice Address - Zip Code:16159-2912
Practice Address - Country:US
Practice Address - Phone:724-977-5527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86050109133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered