Healthcare Provider Details

I. General information

NPI: 1023737236
Provider Name (Legal Business Name): MURRAY KINCH WOOD RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5213 MANDORA CT
NORTH CHESTERFIELD VA
23237-2476
US

IV. Provider business mailing address

5213 MANDORA CT
NORTH CHESTERFIELD VA
23237-2476
US

V. Phone/Fax

Practice location:
  • Phone: 804-721-4696
  • Fax:
Mailing address:
  • Phone: 804-721-4696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number1029810
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1029810
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: