Healthcare Provider Details

I. General information

NPI: 1013826536
Provider Name (Legal Business Name): KATHERINE TYLER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10243 E WATSON RD
SAINT LOUIS MO
63127-1406
US

IV. Provider business mailing address

10243 E WATSON RD
SAINT LOUIS MO
63127-1406
US

V. Phone/Fax

Practice location:
  • Phone: 314-954-3711
  • Fax:
Mailing address:
  • Phone: 314-954-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2026014670
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: