Healthcare Provider Details

I. General information

NPI: 1871426783
Provider Name (Legal Business Name): KATHERINE LEWIE REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 ADCOX RD
PICAYUNE MS
39466-2724
US

IV. Provider business mailing address

1700 ADCOX RD
PICAYUNE MS
39466-2724
US

V. Phone/Fax

Practice location:
  • Phone: 769-356-8265
  • Fax:
Mailing address:
  • Phone: 769-356-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-1468
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: