Provider Demographics
NPI:1114423902
Name:TALBERT, KIRSTINE OLIVIA
Entity Type:Individual
Prefix:
First Name:KIRSTINE
Middle Name:OLIVIA
Last Name:TALBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 EDS LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3501
Mailing Address - Country:US
Mailing Address - Phone:501-539-1415
Mailing Address - Fax:
Practice Address - Street 1:14 EDS LN
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-3501
Practice Address - Country:US
Practice Address - Phone:501-539-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered