Provider Demographics
NPI:1740446350
Name:WEEMS, MARY KATE (PHD, RD, CSSD, LD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATE
Last Name:WEEMS
Suffix:
Gender:F
Credentials:PHD, RD, CSSD, LD
Other - Prefix:DR
Other - First Name:SUZY
Other - Middle Name:
Other - Last Name:WEEMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, RD, CSSD, LD
Mailing Address - Street 1:1109 CASTLE BLUFF CIR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7565
Mailing Address - Country:US
Mailing Address - Phone:936-554-3508
Mailing Address - Fax:254-848-9300
Practice Address - Street 1:1109 CASTLE BLUFF CIR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7565
Practice Address - Country:US
Practice Address - Phone:936-554-3508
Practice Address - Fax:254-848-9300
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT00211133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered