Organization
LISA A KENNEDY, RD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA A KENNEDY RD (SOLE MEMBER)
(936) 628-9123
Entity
Organization
Contact information
Practice address
4635 NE STALLINGS DR STE 104, NACOGDOCHES, TX 75965-1667
(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
08/26/2018
Last updated
08/26/2018
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