Provider Demographics
NPI:1932396892
Name:WILLSON, KATE FIREOVID (RD)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:FIREOVID
Last Name:WILLSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:MARIE
Other - Last Name:FIREOVID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4201 CADY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8830
Mailing Address - Country:US
Mailing Address - Phone:617-721-8255
Mailing Address - Fax:
Practice Address - Street 1:4201 CADY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8830
Practice Address - Country:US
Practice Address - Phone:617-721-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005253133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered