Provider Demographics
NPI:1659691095
Name:MACHER, KRISTINA R (RD,, LD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:R
Last Name:MACHER
Suffix:
Gender:F
Credentials:RD,, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5330
Mailing Address - Country:US
Mailing Address - Phone:903-753-1144
Mailing Address - Fax:903-753-1145
Practice Address - Street 1:712 N HIGH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5330
Practice Address - Country:US
Practice Address - Phone:903-753-1144
Practice Address - Fax:903-753-1145
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82585133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered