Provider Demographics
NPI:1417287673
Name:WILKES, KRISTIN J (RD, CDOE)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:J
Last Name:WILKES
Suffix:
Gender:F
Credentials:RD, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 KAREE CT
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2350
Mailing Address - Country:US
Mailing Address - Phone:401-862-5886
Mailing Address - Fax:
Practice Address - Street 1:31 KAREE CT
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-2350
Practice Address - Country:US
Practice Address - Phone:401-862-5886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00402133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education