Provider Demographics
NPI:1629240981
Name:BREWSTER, KRISTA NICHOLE (MS RD/LD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:NICHOLE
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:MS RD/LD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:NICHOLE
Other - Last Name:LANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD/LD
Mailing Address - Street 1:2727 W HOLCOMBE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1669
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:2727 W HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1669
Practice Address - Country:US
Practice Address - Phone:713-442-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1441133V00000X
TXDT82534133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK130681320OtherNORMAN REGIONAL HOSPITAL