Provider Demographics
NPI:1780848572
Name:BUTTERMORE, KRISTIN A (RD, LD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:BUTTERMORE
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 1:603 S PRAIRIE AVE # 1
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-4227
Mailing Address - Country:US
Mailing Address - Phone:402-681-6095
Mailing Address - Fax:
Practice Address - Street 1:603 S PRAIRIE AVE # 1
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-4227
Practice Address - Country:US
Practice Address - Phone:402-681-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1432133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered