Provider Demographics
NPI:1811329147
Name:ANDREW, KATHERINE GIBSON (MPH, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:GIBSON
Last Name:ANDREW
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 BYRD ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1411
Mailing Address - Country:US
Mailing Address - Phone:919-559-9475
Mailing Address - Fax:
Practice Address - Street 1:2311 BYRD ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-1411
Practice Address - Country:US
Practice Address - Phone:919-559-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003195133V00000X
NC995338133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered