Individual
DESTINY KIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
3131 TAMARACK CT APT 1008, EVANSVILLE, IN 47715-8004
(812) 486-9323
Mailing address
6810 E US HIGHWAY 50, MONTGOMERY, IN 47558-5318
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37003390A
IN
Other
Enumeration date
03/24/2022
Last updated
04/15/2022
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