Provider Demographics
NPI:1063765097
Name:PRICE, KATHRYN PICTON (RD, LD, CNSC)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:PICTON
Last Name:PRICE
Suffix:
Gender:F
Credentials:RD, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 WHITFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-5312
Mailing Address - Country:US
Mailing Address - Phone:210-912-7941
Mailing Address - Fax:
Practice Address - Street 1:4221 WHITFIELD AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-5312
Practice Address - Country:US
Practice Address - Phone:210-912-7941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82035133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered