Individual
LISA KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
4635 NE STALLINGS DR STE 104, NACOGDOCHES, TX 75965
(936) 628-9123
Mailing address
PO BOX 538, ETOILE, TX 75944-0538
(936) 628-9123
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT07616
TX
Other
Enumeration date
10/04/2010
Last updated
08/12/2018
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