Provider Demographics
NPI:1598466245
Name:HOLMSKOG, KRISTIN (RD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HOLMSKOG
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 1:308 W 8TH ST APT 513
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-1587
Mailing Address - Country:US
Mailing Address - Phone:503-810-0083
Mailing Address - Fax:
Practice Address - Street 1:DWIGHT D. EISENHOWER VA MEDICAL CENTER
Practice Address - Street 2:L-120 NUTRITION AND FOOD SERVICE
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048
Practice Address - Country:US
Practice Address - Phone:916-682-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
831550133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered