Provider Demographics
NPI:1154157030
Name:SURBER, KATHRYN S (RD)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:S
Last Name:SURBER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:SURBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:720 PROSPECT HILL DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-4516
Mailing Address - Country:US
Mailing Address - Phone:252-649-8622
Mailing Address - Fax:
Practice Address - Street 1:720 PROSPECT HILL DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4516
Practice Address - Country:US
Practice Address - Phone:252-649-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002371133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered