Provider Demographics
NPI:1710796404
Name:GREEN, KINSI RAE (RDN, LD, NASM-CPT)
Entity type:Individual
Prefix:
First Name:KINSI
Middle Name:RAE
Last Name:GREEN
Suffix:
Gender:F
Credentials:RDN, LD, NASM-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 FANTACY LN
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-8972
Mailing Address - Country:US
Mailing Address - Phone:270-210-9159
Mailing Address - Fax:
Practice Address - Street 1:155 FANTACY LN
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-8972
Practice Address - Country:US
Practice Address - Phone:270-210-9159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered