Provider Demographics
NPI:1942463203
Name:THORNTON-KINARD, TRACEY ELAINE (RD)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:ELAINE
Last Name:THORNTON-KINARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:TRACEY
Other - Middle Name:ELAINE
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:215 PERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-3725
Mailing Address - Country:US
Mailing Address - Phone:334-272-4670
Mailing Address - Fax:334-273-6251
Practice Address - Street 1:215 PERRY HILL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-3725
Practice Address - Country:US
Practice Address - Phone:334-272-4670
Practice Address - Fax:334-273-6251
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL80133V00000X
R711523133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered