Provider Demographics
NPI:1609342351
Name:KEEN, KRISTEN (RD, LDN)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KEEN
Suffix:
Gender:
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 830242
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1014 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1141
Practice Address - Country:US
Practice Address - Phone:502-530-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-21
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1164133V00000X
IL164.007931133V00000X
MTMED-NUTR-LIC-80272133V00000X
LA3080133V00000X
TXDT86292133V00000X
KY285809133V00000X
TNLDN0000002835133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered