Healthcare Provider Details

I. General information

NPI: 1225813942
Provider Name (Legal Business Name): KATHRYN LEE CUPPLES RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

6865 OLD WATERLOO RD APT 1822
ELKRIDGE MD
21075-7130
US

V. Phone/Fax

Practice location:
  • Phone: 713-820-0609
  • Fax:
Mailing address:
  • Phone: 713-820-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: