Provider Demographics
NPI:1194174581
Name:CROSBY, KRISTIN (MS, RD, CSSD, LD)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:CROSBY
Suffix:
Gender:F
Credentials:MS, RD, CSSD, LD
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:1909 KEY BLVD APT 556
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3228
Mailing Address - Country:US
Mailing Address - Phone:505-620-2722
Mailing Address - Fax:
Practice Address - Street 1:15825 SHADY GROVE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4008
Practice Address - Country:US
Practice Address - Phone:301-869-9776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3918133V00000X
NMLD-0608133V00000X
DCDI100000787133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered