Provider Demographics
NPI:1679862890
Name:CRUMPTON, MARY D (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:D
Last Name:CRUMPTON
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 1:1398 CARROLLTON CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3896
Mailing Address - Country:US
Mailing Address - Phone:336-904-0300
Mailing Address - Fax:336-904-0361
Practice Address - Street 1:649 FIRETOWER RD.
Practice Address - Street 2:
Practice Address - City:YANCEYVILLE
Practice Address - State:NC
Practice Address - Zip Code:27379
Practice Address - Country:US
Practice Address - Phone:336-694-4857
Practice Address - Fax:336-694-4857
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC727007133V00000X
NCL001650133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered