Provider Demographics
NPI:1679994339
Name:DAVID, KIRSTEN M (RND)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:M
Last Name:DAVID
Suffix:
Gender:F
Credentials:RND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MEDICAL GROUP
Mailing Address - Street 2:7219 N. LITCHFIELD RD
Mailing Address - City:LUKE AFB
Mailing Address - State:AZ
Mailing Address - Zip Code:85309
Mailing Address - Country:US
Mailing Address - Phone:623-856-4552
Mailing Address - Fax:
Practice Address - Street 1:7219 N LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:LUKE AFB
Practice Address - State:AZ
Practice Address - Zip Code:85309-1529
Practice Address - Country:US
Practice Address - Phone:281-382-6748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered