Provider Demographics
NPI:1932558509
Name:PRAFKA, KATHRYN RUDISILL (RD/LDN, CDE)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RUDISILL
Last Name:PRAFKA
Suffix:
Gender:F
Credentials:RD/LDN, CDE
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LEE
Other - Last Name:RUDISILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4200 LAKE BOONE TRL
Mailing Address - Street 2:REX NUTRITION SERVICES
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6521
Mailing Address - Country:US
Mailing Address - Phone:919-784-1303
Mailing Address - Fax:919-784-1397
Practice Address - Street 1:4200 LAKE BOONE TRL
Practice Address - Street 2:REX NUTRITION SERVICES
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-784-1303
Practice Address - Fax:919-784-1397
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004631133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist