Provider Demographics
NPI:1891367652
Name:WOOSLEY, KYNDRA (RDN)
Entity Type:Individual
Prefix:
First Name:KYNDRA
Middle Name:
Last Name:WOOSLEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29060 HORNER LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-7746
Mailing Address - Country:US
Mailing Address - Phone:909-499-5193
Mailing Address - Fax:
Practice Address - Street 1:29060 HORNER LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-7746
Practice Address - Country:US
Practice Address - Phone:909-499-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1068675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered