Provider Demographics
NPI:1194128652
Name:PARKER, KATHRYN (RD, LD/N)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SW ARCHER RD
Mailing Address - Street 2:ROOM 2108
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1136
Mailing Address - Country:US
Mailing Address - Phone:352-265-8548
Mailing Address - Fax:352-265-8425
Practice Address - Street 1:2000 SW ARCHER RD
Practice Address - Street 2:ROOM 2108
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1136
Practice Address - Country:US
Practice Address - Phone:352-265-8548
Practice Address - Fax:352-265-8425
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 736133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN00AYOtherBC/BS
FLHY988ZMedicare PIN