Provider Demographics
NPI:1639709629
Name:WALSH, KRISTIN (RDN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44008 ABERDEEN TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3825
Mailing Address - Country:US
Mailing Address - Phone:757-812-4041
Mailing Address - Fax:
Practice Address - Street 1:44008 ABERDEEN TER
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3825
Practice Address - Country:US
Practice Address - Phone:757-812-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered