Provider Demographics
NPI:1376553958
Name:HAMBLIN, KYNDRA ELISE (RD,LD)
Entity Type:Individual
Prefix:
First Name:KYNDRA
Middle Name:ELISE
Last Name:HAMBLIN
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:KYNDRA
Other - Middle Name:ELISE
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2349 MILSTEAD COURT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209
Mailing Address - Country:US
Mailing Address - Phone:316-516-2890
Mailing Address - Fax:
Practice Address - Street 1:2349 S MILSTEAD CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-3610
Practice Address - Country:US
Practice Address - Phone:316-516-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00401133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered