Provider Demographics
NPI:1548465305
Name:KINNISON, MEGAN MARIE (RD, LD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:KINNISON
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 1:437 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-1366
Mailing Address - Country:US
Mailing Address - Phone:740-707-4330
Mailing Address - Fax:
Practice Address - Street 1:437 N HIGH ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1366
Practice Address - Country:US
Practice Address - Phone:740-707-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5760133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered