Healthcare Provider Details

I. General information

NPI: 1407362163
Provider Name (Legal Business Name): KATHERINE J IRWIN MS, RD, LDN, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY J IRWIN MS, RD, LDN, CNSC

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 OAK RIDGE TPKE
OAK RIDGE TN
37830-6976
US

IV. Provider business mailing address

7420 STONINGTON LN
KNOXVILLE TN
37931-1859
US

V. Phone/Fax

Practice location:
  • Phone: 865-835-4118
  • Fax: 865-835-4122
Mailing address:
  • Phone: 865-919-5426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2023
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2023
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: