Provider Demographics
NPI:1538669585
Name:FITZSIMMONS, KRISTEN (MS, RD, LDN, CDCES)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:MS, RD, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SUMMER ST STE 535
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:508-363-5189
Mailing Address - Fax:508-363-7188
Practice Address - Street 1:123 SUMMER ST STE 535
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-5189
Practice Address - Fax:508-363-7188
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00941133VN1004X
MA4329133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric