Provider Demographics
NPI:1700354768
Name:HAIRE, KENDRA ANNE (RDN)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:ANNE
Last Name:HAIRE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:ANNE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2624 WAR WAGON WAY
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-4337
Mailing Address - Country:US
Mailing Address - Phone:571-243-4303
Mailing Address - Fax:
Practice Address - Street 1:2624 WAR WAGON WAY
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-4337
Practice Address - Country:US
Practice Address - Phone:571-243-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85371133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered