Provider Demographics
NPI:1235502915
Name:COMER, KRISTINA (RD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:COMER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 E BAYAUD AVE
Mailing Address - Street 2:APT 715
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3345
Mailing Address - Country:US
Mailing Address - Phone:706-457-2766
Mailing Address - Fax:
Practice Address - Street 1:3329 E BAYAUD AVE
Practice Address - Street 2:APT 715
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3345
Practice Address - Country:US
Practice Address - Phone:706-457-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86007131133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered