Provider Demographics
NPI:1417242496
Name:MCEVOY, KIRSTEN LEAH (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LEAH
Last Name:MCEVOY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:LEAH
Other - Last Name:MCEVOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:51 CHARLTON ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01540-2139
Mailing Address - Country:US
Mailing Address - Phone:508-731-0415
Mailing Address - Fax:
Practice Address - Street 1:100 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4051
Practice Address - Country:US
Practice Address - Phone:508-765-2294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2833133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered