Provider Demographics
NPI:1972238061
Name:GREEN, KRISTEN (MDS, RDN, LD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MDS, RDN, LD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MDS, RDN, LD
Mailing Address - Street 1:1941 KEESE SAGEBIEL RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-6987
Mailing Address - Country:US
Mailing Address - Phone:830-998-0061
Mailing Address - Fax:
Practice Address - Street 1:1941 KEESE SAGEBIEL RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-6987
Practice Address - Country:US
Practice Address - Phone:830-998-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management