Provider Demographics
NPI:1750698957
Name:PATETTA, KATHRYN MCKERNAN (RD)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MCKERNAN
Last Name:PATETTA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 GRAMPIAN BLVD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1909
Mailing Address - Country:US
Mailing Address - Phone:570-326-8410
Mailing Address - Fax:570-326-8414
Practice Address - Street 1:1100 GRAMPIAN BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1909
Practice Address - Country:US
Practice Address - Phone:570-326-8410
Practice Address - Fax:570-326-8414
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003214133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered