MEDICARE: MS. KATHLEEN MALM BURN MS, RD, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1005X	Renal Nutrition Registered Dietitian	0000001131	TN

General Provider Information

NPI Number	:	1780687012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN MALM BURN MS, RD, LDN

Provider Business Mailing Address
First Line	:	913 CHESAPEAKE WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-6716
Country	:	US
Telephone Number	:	865-691-3110
Fax Number	:	865-691-3110

Provider Business Practice Location Address
First Line	:	913 CHESAPEAKE WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-6716
Country	:	US
Telephone Number	:	865-691-3110
Fax Number	:	865-691-3110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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