Provider Demographics
NPI:1912197898
Name:KINSER, SELMA L (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:SELMA
Middle Name:L
Last Name:KINSER
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 1:3103 BRONZE LEAF DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-7795
Mailing Address - Country:US
Mailing Address - Phone:870-236-4081
Mailing Address - Fax:870-236-4081
Practice Address - Street 1:3103 BRONZE LEAF
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-7795
Practice Address - Country:US
Practice Address - Phone:870-236-4081
Practice Address - Fax:870-236-4081
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR460133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered