Provider Demographics
NPI:1831139310
Name:KINSEY, JILL SUZANNE (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SUZANNE
Last Name:KINSEY
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45024 CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43968-9723
Mailing Address - Country:US
Mailing Address - Phone:330-532-4873
Mailing Address - Fax:
Practice Address - Street 1:101 E SIXTH ST
Practice Address - Street 2:211
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-3086
Practice Address - Country:US
Practice Address - Phone:330-385-4750
Practice Address - Fax:330-385-4720
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5536133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered