Provider Demographics
NPI:1073859336
Name:KINSON, LYNNE (MS)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:
Last Name:KINSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8506 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8274
Mailing Address - Country:US
Mailing Address - Phone:208-755-2437
Mailing Address - Fax:
Practice Address - Street 1:8506 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8274
Practice Address - Country:US
Practice Address - Phone:208-755-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID03050133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education