Healthcare Provider Details

I. General information

NPI: 1295195451
Provider Name (Legal Business Name): KATHERINE FANN MS, RD, LD, CSWOMCDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE LAMBERT RD, LD

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 MANITOU DR
SAINT LOUIS MO
63119-1229
US

IV. Provider business mailing address

1315 SAN JACINTO CT
SAINT LOUIS MO
63139-3703
US

V. Phone/Fax

Practice location:
  • Phone: 303-717-2972
  • Fax:
Mailing address:
  • Phone: 303-717-2972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2012024505
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: