Provider Demographics
NPI:1710007240
Name:KENYON, ROSEMARY KIRK (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:KIRK
Last Name:KENYON
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 1:5105 W CONCORD RD
Mailing Address - Street 2:ROSEMARYKENYON@COMCAST.NET
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-6517
Mailing Address - Country:US
Mailing Address - Phone:615-319-8638
Mailing Address - Fax:615-671-9053
Practice Address - Street 1:5105 W CONCORD RD
Practice Address - Street 2:ROSEMARYKENYON@COMCAST.NET
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-6517
Practice Address - Country:US
Practice Address - Phone:615-319-8638
Practice Address - Fax:615-671-9053
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000001196133V00000X, 133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN982Medicaid