Provider Demographics
NPI:1275221996
Name:GRIMES, KRISTIN (RDN, LD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:GRIMES
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 INGALLS ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-4132
Mailing Address - Country:US
Mailing Address - Phone:763-464-6330
Mailing Address - Fax:
Practice Address - Street 1:6659 INGALLS ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-4132
Practice Address - Country:US
Practice Address - Phone:763-464-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4344133V00000X
NCL007173133V00000X
TXDT88159133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered