Healthcare Provider Details

I. General information

NPI: 1811240724
Provider Name (Legal Business Name): KATILEAN,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 SOUTHWEST PKWY APT 222
AUSTIN TX
78735-6242
US

IV. Provider business mailing address

5604 SOUTHWEST PKWY APT 222
AUSTIN TX
78735-6242
US

V. Phone/Fax

Practice location:
  • Phone: 210-862-4105
  • Fax:
Mailing address:
  • Phone: 210-862-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MISS KATHERINE ELIZABETH HALL
Title or Position: DIRECTOR
Credential: RD LD
Phone: 210-862-4105