Provider Demographics
NPI:1497347793
Name:CONEY, KENDALL MORGAN (RDN)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:MORGAN
Last Name:CONEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 DORCHESTER CT STE 1
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6546
Mailing Address - Country:US
Mailing Address - Phone:260-564-4401
Mailing Address - Fax:
Practice Address - Street 1:2024 DORCHESTER CT STE 1
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6546
Practice Address - Country:US
Practice Address - Phone:260-564-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003302A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered