Provider Demographics
NPI:1619859782
Name:ANTONOPULOS, KATHRYN GRACE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRACE
Last Name:ANTONOPULOS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9372 N COLLIERVILLE ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9519
Mailing Address - Country:US
Mailing Address - Phone:731-443-1418
Mailing Address - Fax:
Practice Address - Street 1:6263 POPLAR AVE STE 605
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4724
Practice Address - Country:US
Practice Address - Phone:901-343-6146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5146133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered