Provider Demographics
NPI:1427046242
Name:PARKER, KATHERINE (RD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:PARKER
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 1:2509 CAPITOL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5808
Mailing Address - Country:US
Mailing Address - Phone:916-455-1155
Mailing Address - Fax:916-455-1195
Practice Address - Street 1:2509 CAPITOL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5808
Practice Address - Country:US
Practice Address - Phone:916-455-1155
Practice Address - Fax:916-455-1195
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA846665133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALICENSEOther846665