Provider Demographics
NPI:1063985539
Name:MCCARTNEY, KATHERINE JOAN (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:JOAN
Last Name:MCCARTNEY
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 TACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-2263
Mailing Address - Country:US
Mailing Address - Phone:509-837-1500
Mailing Address - Fax:509-837-1693
Practice Address - Street 1:812 MILLER AVE STE B
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2377
Practice Address - Country:US
Practice Address - Phone:509-837-1673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA872544133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered