Active NPI
Kendra M Clark, RD,LDN
- Registered Dietitian
- Havre de Grace, MD
National Provider Identifier
1457491870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- D02324
- Practice address
- 501 S Union Ave
Food and Nutrition Department
Havre de Grace, MD 21078-3409 - Phone
- (443) 843-5262
- Fax
- (443) 643-2170
- NPI assigned
- Feb 7, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | D02324 | MD | Primary |
Addresses
Primary practice location
501 S Union Ave
Food and Nutrition Department
Havre de Grace, MD 21078-3409
Mailing address
501 S Union Ave
Food and Nutrition Department
Havre de Grace, MD 21078-3409
Phone (443) 843-5262
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D02324 | MD | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457491870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 S UNION AVE",
"address_2": "FOOD AND NUTRITION DEPARTMENT",
"city": "HAVRE DE GRACE",
"state": "MD",
"postal_code": "210783409",
"telephone_number": "443-843-5262",
"fax_number": "443-643-2170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 S UNION AVE",
"address_2": "FOOD AND NUTRITION DEPARTMENT",
"city": "HAVRE DE GRACE",
"state": "MD",
"postal_code": "210783409",
"telephone_number": "443-843-5262",
"fax_number": "443-643-2170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KENDRA",
"middle_name": "M",
"credential": "RD,LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MD",
"license": "D02324",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Havre de Grace, MD
- Helen Marie Ciesla, M.S., NCC, LCPC
- Citizens Nursing Home Board of Harford County (Citizens Care & Rehabilitation Center)
- Citizens Pharmacy Services Inc
- Citizens Pharmacy Services Inc
- Krysten Clark Wilkes, BCBA, LBA
- Meredith Katherine Clark, O. D.
- Donovan Rochlitz Clifford, MSPT
- Melodie Cobb-Miller, BCBA LBA
- Nikia S. Coefield, PHARMD
- Hillary Coggins, LSW, BCBA, LBA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.