Provider Demographics
NPI:1912245556
Name:DAVIS, KATHY ANN (RD, CSP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RD, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 SANDAL WAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8983
Mailing Address - Country:US
Mailing Address - Phone:812-490-6766
Mailing Address - Fax:
Practice Address - Street 1:1977 SANDAL WAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8983
Practice Address - Country:US
Practice Address - Phone:812-490-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric