Healthcare Provider Details

I. General information

NPI: 1952808172
Provider Name (Legal Business Name): KENDRA SEAGRAVES RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E WASHINGTON AVE STE 430-18
JACKSON MI
49201-2393
US

IV. Provider business mailing address

209 E WASHINGTON AVE STE 430-18
JACKSON MI
49201-2393
US

V. Phone/Fax

Practice location:
  • Phone: 517-740-4766
  • Fax: 517-247-3309
Mailing address:
  • Phone: 517-740-4766
  • Fax: 517-247-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86080791
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: