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General NPI Number Information
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NPI Number | 1215090741
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Entity Type | Individual
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Provider Name | KATHLEEN M. KENNEDY HUTTON RD
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 300 HARDING BLVD SUITE 203C
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City | ROSEVILLE
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State | CA
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Zip | 95678-2470
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Country | US
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Telephone | 916-717-5962
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Fax | 916-419-2114
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Provider Business Mailing Address
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Address Line | 1741 BAINES AVE
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City | SACRAMENTO
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State | CA
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Zip | 95835-1221
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Country | US
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Telephone | 916-717-5962
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Fax | 916-419-2114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 819336
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License Number State | IL
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