Provider Demographics
NPI:1154134658
Name:TYBURSKI, KATHRYN JANE (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JANE
Last Name:TYBURSKI
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:JANE
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:5747 SHAWN TER
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1533
Mailing Address - Country:US
Mailing Address - Phone:305-934-1910
Mailing Address - Fax:
Practice Address - Street 1:5747 SHAWN TER
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1533
Practice Address - Country:US
Practice Address - Phone:305-934-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005421133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered