Provider Demographics
NPI:1386354348
Name:WHITAKER, KRISTIN (NTM, RWS, NANP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:NTM, RWS, NANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7341 S TICO DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-4102
Mailing Address - Country:US
Mailing Address - Phone:801-808-6524
Mailing Address - Fax:
Practice Address - Street 1:7341 S TICO DR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-4102
Practice Address - Country:US
Practice Address - Phone:801-808-6524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education