Provider Demographics
NPI:1346838711
Name:FARR, KENDALL CECILIA (MS RD LDN)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:CECILIA
Last Name:FARR
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W 25TH ST APT 1136
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-2842
Mailing Address - Country:US
Mailing Address - Phone:678-907-1194
Mailing Address - Fax:
Practice Address - Street 1:14509 S OLD STATESVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-9655
Practice Address - Country:US
Practice Address - Phone:704-266-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-01
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006300133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered