Provider Demographics
NPI:1407658941
Name:MATHEWS, MADISON KATE (RD, LDN)
Entity type:Individual
Prefix:MISS
First Name:MADISON
Middle Name:KATE
Last Name:MATHEWS
Suffix:
Gender:
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 COLEMAN BLVD UNIT 1101
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6010
Mailing Address - Country:US
Mailing Address - Phone:815-641-2896
Mailing Address - Fax:
Practice Address - Street 1:656 COLEMAN BLVD UNIT 1101
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6010
Practice Address - Country:US
Practice Address - Phone:815-641-2896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLRD.2839.RD133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered