Provider Demographics
NPI:1588727598
Name:STATE OF FLORIDA, DOH, BCHD
Entity type:Organization
Organization Name:STATE OF FLORIDA, DOH, BCHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PUBLIC HEALTH NUTRITIONIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:850-872-4666
Mailing Address - Street 1:597 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2330
Mailing Address - Country:US
Mailing Address - Phone:850-872-4666
Mailing Address - Fax:
Practice Address - Street 1:597 W 11TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2330
Practice Address - Country:US
Practice Address - Phone:850-872-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 3566251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1261ZMedicare ID - Type UnspecifiedLICENSED DIETITIAN