Provider Demographics
NPI:1902237456
Name:GREEN, KATHRYN (RD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:GREEN
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 1:2029 AIRPORT BLVD STE 195
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-1754
Mailing Address - Country:US
Mailing Address - Phone:251-478-2233
Mailing Address - Fax:251-272-9961
Practice Address - Street 1:2029 AIRPORT BLVD STE 195
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-1754
Practice Address - Country:US
Practice Address - Phone:251-478-2233
Practice Address - Fax:251-272-9961
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2392133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered