Provider Demographics
NPI:1760865158
Name:LOECHEL, KRISTEN KIMBERLY (MS, RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KIMBERLY
Last Name:LOECHEL
Suffix:
Gender:F
Credentials:MS, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 CALAVERAS DR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4002
Mailing Address - Country:US
Mailing Address - Phone:678-429-0452
Mailing Address - Fax:
Practice Address - Street 1:3550 PRESTON RIDGE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3821
Practice Address - Country:US
Practice Address - Phone:770-663-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003571133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered