Provider Demographics
NPI:1134462518
Name:NEUSEL, KRISTIN (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:NEUSEL
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 PARK COMMONS CT.
Mailing Address - Street 2:APT. L
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088
Mailing Address - Country:US
Mailing Address - Phone:618-340-0713
Mailing Address - Fax:
Practice Address - Street 1:10010 KENNERLY RD.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-525-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012039995133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered