Provider Demographics
NPI:1588986798
Name:WHITTINGTON, KRISTIN LEIGH (RD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEIGH
Last Name:WHITTINGTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CEDAR ST SE
Mailing Address - Street 2:STE. 5640
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4917
Mailing Address - Country:US
Mailing Address - Phone:505-843-6168
Mailing Address - Fax:505-247-9743
Practice Address - Street 1:201 CEDAR ST SE
Practice Address - Street 2:STE. 5640
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4917
Practice Address - Country:US
Practice Address - Phone:505-843-6168
Practice Address - Fax:505-247-9743
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0759133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83735763Medicaid
NMNM303265Medicare PIN