Healthcare Provider Details

I. General information

NPI: 1780687012
Provider Name (Legal Business Name): KATHLEEN MALM BURN MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 CHESAPEAKE WAY
KNOXVILLE TN
37923-6716
US

IV. Provider business mailing address

913 CHESAPEAKE WAY
KNOXVILLE TN
37923-6716
US

V. Phone/Fax

Practice location:
  • Phone: 865-691-3110
  • Fax: 865-691-3110
Mailing address:
  • Phone: 865-691-3110
  • Fax: 865-691-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number0000001131
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: