Provider Demographics
NPI:1720390669
Name:NIESSINK, KRISTIN LEE (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:NIESSINK
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DAVOL SQ
Mailing Address - Street 2:STE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4752
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:951 AQUIDNECK AVE
Practice Address - Street 2:BRIDGE TO FITNESS
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7202
Practice Address - Country:US
Practice Address - Phone:401-368-7614
Practice Address - Fax:401-619-0816
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00545133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered