Provider Demographics
NPI:1871465690
Name:MOORE-GREGORY, ALICE KATHLEEN (RDN, LD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:KATHLEEN
Last Name:MOORE-GREGORY
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:MOORE-GREGORY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:67 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-8025
Mailing Address - Country:US
Mailing Address - Phone:505-410-1922
Mailing Address - Fax:
Practice Address - Street 1:67 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-8025
Practice Address - Country:US
Practice Address - Phone:505-410-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1290133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered