Provider Demographics
NPI:1457491870
Name:CLARK, KENDRA M (RD,LDN)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:M
Last Name:CLARK
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S UNION AVE
Mailing Address - Street 2:FOOD AND NUTRITION DEPARTMENT
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3409
Mailing Address - Country:US
Mailing Address - Phone:443-843-5262
Mailing Address - Fax:443-643-2170
Practice Address - Street 1:501 S UNION AVE
Practice Address - Street 2:FOOD AND NUTRITION DEPARTMENT
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3409
Practice Address - Country:US
Practice Address - Phone:443-843-5262
Practice Address - Fax:443-643-2170
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02324133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered