Provider Demographics
NPI:1952909202
Name:KLATT, KEVIN CONNOLLY
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CONNOLLY
Last Name:KLATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1441
Mailing Address - Country:US
Mailing Address - Phone:267-978-8889
Mailing Address - Fax:
Practice Address - Street 1:4607 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1441
Practice Address - Country:US
Practice Address - Phone:267-978-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86166133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT86166OtherLICENSED DIETITIAN