MEDICARE: MISS KATHERINE FAY KINES 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	282NC2000X	Children's Hospital	LDN0000002491	TN

General Provider Information

NPI Number	:	1861814634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATHERINE FAY KINES MS, RD, LDN

Provider Business Mailing Address
First Line	:	1211 21ST AVE S
Second Line	:	607 MEDICAL ARTS BUILDING
City	:	NASHVILLE
State	:	TN
Zip	:	37232-1030
Country	:	US
Telephone Number	:	615-936-4991
Fax Number	:	615-935-3956

Provider Business Practice Location Address
First Line	:	1211 21ST AVE S
Second Line	:	607 MEDICAL ARTS BUILDING
City	:	NASHVILLE
State	:	TN
Zip	:	37232-1030
Country	:	US
Telephone Number	:	615-936-4991
Fax Number	:	615-935-3956

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

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/14/2014

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