Provider Demographics
NPI:1831080357
Name:BOOTHE, KRISTINE (RDN)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 SMILEY WYRICK RD
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9728
Mailing Address - Country:US
Mailing Address - Phone:585-406-4991
Mailing Address - Fax:
Practice Address - Street 1:5460 SMILEY WYRICK RD
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-9728
Practice Address - Country:US
Practice Address - Phone:585-406-4991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-12
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86391804133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered