Organization
NUTRITION SENSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRY GREEN RD, LD (OWNER)
(210) 415-0165
Entity
Organization
Contact information
Practice address
110 DOVE CREST DR, BOERNE, TX 78006-7828
(210) 415-0165
(888) 512-4765
Mailing address
265 N MAIN ST, BOERNE, TX 78006-2035
(210) 415-0165
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT04664
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TXB127190
MEDICARE PTAN
TX
Enumeration date
08/06/2012
Last updated
08/06/2012
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