Provider Demographics
NPI:1730335431
Name:SCOTT, KYRESE ANGELA (MS,RD,LDN)
Entity type:Individual
Prefix:MRS
First Name:KYRESE
Middle Name:ANGELA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10708 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20623-1107
Mailing Address - Country:US
Mailing Address - Phone:301-782-7007
Mailing Address - Fax:
Practice Address - Street 1:10708 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:MD
Practice Address - Zip Code:20623-1107
Practice Address - Country:US
Practice Address - Phone:301-782-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2762133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered