Provider Demographics
NPI:1962073627
Name:FITHIAN, TABITHA KAI (RD)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:KAI
Last Name:FITHIAN
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 1:14101 W HWY 290 STE 1600B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-9394
Mailing Address - Country:US
Mailing Address - Phone:512-522-7793
Mailing Address - Fax:818-484-2316
Practice Address - Street 1:14101 W HWY 290 STE 1600B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-9394
Practice Address - Country:US
Practice Address - Phone:512-522-7793
Practice Address - Fax:818-484-2316
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86170769133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered