Provider Demographics
NPI:1093043341
Name:BEACH, KRISTEN BRYDA (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:BRYDA
Last Name:BEACH
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH
Other - Last Name:BYDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:608 SCALES TOWNE COURT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608
Mailing Address - Country:US
Mailing Address - Phone:831-206-4309
Mailing Address - Fax:
Practice Address - Street 1:608 SCALES TOWNE COURT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608
Practice Address - Country:US
Practice Address - Phone:831-206-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00982532133V00000X
NCL009232133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered