Provider Demographics
NPI:1518764828
Name:ENDRIS, KATHERINE KELLEY (MS, RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:KELLEY
Last Name:ENDRIS
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 COVENTRY WAY
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4723
Mailing Address - Country:US
Mailing Address - Phone:901-484-9505
Mailing Address - Fax:
Practice Address - Street 1:406 COVENTRY WAY
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4723
Practice Address - Country:US
Practice Address - Phone:901-484-9505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2687133V00000X
AL5148133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered