Individual
MARY KATHRYN TEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 867-4000
(228) 867-5009
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 867-4000
(228) 867-5009
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D1330
MS
133V00000X
Registered Dietitian
ND 5295
FL
Other
Enumeration date
08/20/2008
Last updated
08/20/2008
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