Provider Demographics
NPI:1366808313
Name:LINVILLE, KATIE (RDN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:LINVILLE
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 HAWKS LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9655
Mailing Address - Country:US
Mailing Address - Phone:850-384-1959
Mailing Address - Fax:
Practice Address - Street 1:3610 HAWKS LANDING CIR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-9655
Practice Address - Country:US
Practice Address - Phone:850-384-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA133V00000X
AZ133V00000X
NCL007497133V00000X
TXDT85192133V00000X
FLND8367133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered