Provider Demographics
NPI:1528652666
Name:KEARNS, CATHERINE MARGARET (RD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARGARET
Last Name:KEARNS
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 1:9650 SUMMIT PARK DRIVE
Mailing Address - Street 2:APARTMENT 213
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342
Mailing Address - Country:US
Mailing Address - Phone:516-330-4908
Mailing Address - Fax:
Practice Address - Street 1:DAYTON VA MEDICAL CENTER
Practice Address - Street 2:4100 W. THIRD ST.
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008594133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered