Provider Demographics
NPI:1326015959
Name:KENDALL, MEGAN LEE (RD LD)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LEE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:LEE
Other - Last Name:MAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:306 LOUISIANA RD
Mailing Address - Street 2:
Mailing Address - City:DYERS AFB
Mailing Address - State:TX
Mailing Address - Zip Code:79607
Mailing Address - Country:US
Mailing Address - Phone:325-518-6173
Mailing Address - Fax:325-690-5228
Practice Address - Street 1:765 ORANGE
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603
Practice Address - Country:US
Practice Address - Phone:325-690-5131
Practice Address - Fax:325-690-5228
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06723133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1591135502Medicaid