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NPI Code Detail

MEDICARE: MRS. KATHERINE BUSKER GIBBONS M.S., R.D.N., L.D.N.

MEDICARE: MRS. KATHERINE BUSKER GIBBONS M.S., R.D.N., L.D.N.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian86101326NC

General Provider Information

NPI Number : 1326522475
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHERINE BUSKER GIBBONS M.S., R.D.N., L.D.N.
Provider Business Mailing Address
First Line : 7940 WILLIAMS POND LN STE 150
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-8409
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7940 WILLIAMS POND LN STE 150
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-8409
Country : US
Telephone Number : 704-752-7779
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2018
Last Update Date : 09/24/2018

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