Provider Demographics
NPI:1528688934
Name:THE KATY DIETITIAN, LLC
Entity type:Organization
Organization Name:THE KATY DIETITIAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:LARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:361-298-0920
Mailing Address - Street 1:21700 BELLAIRE BLVD STE 1520
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3913
Mailing Address - Country:US
Mailing Address - Phone:361-298-0920
Mailing Address - Fax:833-706-9444
Practice Address - Street 1:21700 BELLAIRE BLVD STE 1520
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3913
Practice Address - Country:US
Practice Address - Phone:361-298-0920
Practice Address - Fax:833-706-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT82944OtherSTATE LICENCE