Provider Demographics
NPI:1467140525
Name:MOSS, KINSLEY W (MS RD LD)
Entity Type:Individual
Prefix:
First Name:KINSLEY
Middle Name:W
Last Name:MOSS
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 VANESSA DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4432
Mailing Address - Country:US
Mailing Address - Phone:205-515-9361
Mailing Address - Fax:
Practice Address - Street 1:2241 VANESSA DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35242-4432
Practice Address - Country:US
Practice Address - Phone:205-515-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL988772133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered