Provider Demographics
NPI:1750263075
Name:PRIVITT, KATHERINE TANI (RD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:TANI
Last Name:PRIVITT
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 1:12365 E ARKANSAS PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4307
Mailing Address - Country:US
Mailing Address - Phone:319-541-1230
Mailing Address - Fax:
Practice Address - Street 1:12365 E ARKANSAS PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4307
Practice Address - Country:US
Practice Address - Phone:319-541-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA132208133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered