Provider Demographics
NPI:1679873913
Name:DORITY, LAURA N (MS RD LD)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:N
Last Name:DORITY
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:N
Other - Last Name:KENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RD LD
Mailing Address - Street 1:165 ASHLEY AVE
Mailing Address - Street 2:MSC905; EH110B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8905
Mailing Address - Country:US
Mailing Address - Phone:843-792-3467
Mailing Address - Fax:
Practice Address - Street 1:165 ASHLEY AVE
Practice Address - Street 2:MSC905; EH110B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8905
Practice Address - Country:US
Practice Address - Phone:843-792-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN988543133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered