Provider Demographics
NPI:1700446838
Name:KINART, MARY ANN (MS,RD,LD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:KINART
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:OTTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,RD
Mailing Address - Street 1:15228 SADDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3453
Mailing Address - Country:US
Mailing Address - Phone:281-804-7671
Mailing Address - Fax:
Practice Address - Street 1:17200 ST LUKES WAY
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8007
Practice Address - Country:US
Practice Address - Phone:936-266-3654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04273133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered