Provider Demographics
NPI:1093341406
Name:BROWN, KENDALL (RDN/LD)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 STANTON L YOUNG BLVD STE 357
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5020
Mailing Address - Country:US
Mailing Address - Phone:405-271-2058
Mailing Address - Fax:
Practice Address - Street 1:940 STANTON L YOUNG BLVD STE 357
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5020
Practice Address - Country:US
Practice Address - Phone:405-271-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2482133VN1004X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric