Provider Demographics
NPI:1891136974
Name:THOMPSON, GWYNETH MOORE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:GWYNETH
Middle Name:MOORE
Last Name:THOMPSON
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 1:3344B ELLSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4944
Mailing Address - Country:US
Mailing Address - Phone:252-342-4448
Mailing Address - Fax:
Practice Address - Street 1:2610 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2800
Practice Address - Country:US
Practice Address - Phone:252-847-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004171133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered