Provider Demographics
NPI:1306243753
Name:SHATTLER, KATHY JO (RD)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JO
Last Name:SHATTLER
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 1:5550 MALL DR W
Mailing Address - Street 2:# 1108
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-3252
Mailing Address - Country:US
Mailing Address - Phone:517-348-4572
Mailing Address - Fax:
Practice Address - Street 1:5550 MALL DR W
Practice Address - Street 2:# 1108
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-3252
Practice Address - Country:US
Practice Address - Phone:517-574-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00710393133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
00710393OtherCDR CREDENTIALLING NUMBER