=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174472807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KINSEY LORA WATSON RDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2026
-----------------------------------------------------
Last Update Date | 01/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14176 S DIRECTOR VIEW LN
-----------------------------------------------------
City | DRAPER
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84020-7593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-618-3788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14176 S DIRECTOR VIEW LN
-----------------------------------------------------
City | DRAPER
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84020-7593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-618-3788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 86472661
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------