Provider Demographics
NPI:1588118772
Name:KREN, KRISTIN L (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:L
Last Name:KREN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:L
Other - Last Name:KERGOSIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5017
Mailing Address - Country:US
Mailing Address - Phone:283-040-3122
Mailing Address - Fax:502-785-4003
Practice Address - Street 1:201 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5017
Practice Address - Country:US
Practice Address - Phone:228-304-0312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK723133V00000X
AR1996133V00000X
KY279064133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered