Provider Demographics
NPI:1063059889
Name:GARVEY, KATHLEEN (RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:GARVEY
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 SILVER MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80951-3200
Mailing Address - Country:US
Mailing Address - Phone:713-304-8593
Mailing Address - Fax:719-434-9768
Practice Address - Street 1:1666 SILVER MEADOW CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80951-3200
Practice Address - Country:US
Practice Address - Phone:713-304-8593
Practice Address - Fax:719-434-9768
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-01
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1063612133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO894680Medicaid