Provider Demographics
NPI:1962997189
Name:LOPEZ, KATHARINE RENEE (LD)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:RENEE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 BATTERS PLACE RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2713
Mailing Address - Country:US
Mailing Address - Phone:423-463-0618
Mailing Address - Fax:423-825-8145
Practice Address - Street 1:8000 BATTERS PLACE RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2713
Practice Address - Country:US
Practice Address - Phone:423-463-0618
Practice Address - Fax:423-825-8145
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004566133V00000X
TN4056133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered