Provider Demographics
NPI:1326609587
Name:KINNIE, KRISTIN (MSN, MSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:KINNIE
Suffix:
Gender:F
Credentials:MSN, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6376 NE COPPER BEECH DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5168
Mailing Address - Country:US
Mailing Address - Phone:503-648-3683
Mailing Address - Fax:
Practice Address - Street 1:6376 NE COPPER BEECH DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5168
Practice Address - Country:US
Practice Address - Phone:503-648-3683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist