Individual
MR. JASON MATTHEW KINGSBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.D. L.N.
Contact information
Practice address
353 FAIRMONT BLVD, RAPID CITY, SD 57701-7375
(605) 719-8251
Mailing address
3604 SQUIRE LN, RAPID CITY, SD 57702-0523
(402) 350-4624
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0377
SD
Other
Enumeration date
06/20/2012
Last updated
06/20/2012
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