Provider Demographics
NPI:1699176446
Name:TOLBERT, KENDRA NICOLE (MS, RDN, LD, RYT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:NICOLE
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:MS, RDN, LD, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 KINGSLAND AVE UNIT 300068
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-5003
Mailing Address - Country:US
Mailing Address - Phone:314-944-5232
Mailing Address - Fax:
Practice Address - Street 1:561 KINGSLAND AVE UNIT 300068
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-5003
Practice Address - Country:US
Practice Address - Phone:314-944-5232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021046143133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331952Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY00695941Medicaid
NY331944Medicare Oscar/Certification