Provider Demographics
NPI:1124659255
Name:SCOTT, KATHERINE JEANNE (RD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JEANNE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 AMERICAN HOLLY CT
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-3613
Mailing Address - Country:US
Mailing Address - Phone:571-277-1559
Mailing Address - Fax:
Practice Address - Street 1:4413 SOUTHERN BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-2841
Practice Address - Country:US
Practice Address - Phone:571-277-1559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2725133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered