Provider Demographics
NPI:1497379168
Name:GRANER, KAY EDGEWORTH (MNS,RD,LDN,IFNCP)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:EDGEWORTH
Last Name:GRANER
Suffix:
Gender:F
Credentials:MNS,RD,LDN,IFNCP
Other - Prefix:MS
Other - First Name:KAY
Other - Middle Name:E
Other - Last Name:GRANER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MNS,RD,LDN,IFNCP
Mailing Address - Street 1:676 MICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327-8906
Mailing Address - Country:US
Mailing Address - Phone:910-639-2562
Mailing Address - Fax:
Practice Address - Street 1:676 MICHAEL RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NC
Practice Address - Zip Code:28327-8906
Practice Address - Country:US
Practice Address - Phone:910-639-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000607133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered