Provider Demographics
NPI:1811397185
Name:HUNTSMAN, KRISTIN (RDN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HUNTSMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7816 MEADOWVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-1708
Mailing Address - Country:US
Mailing Address - Phone:419-277-3200
Mailing Address - Fax:
Practice Address - Street 1:7816 MEADOWVIEW LN
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-1708
Practice Address - Country:US
Practice Address - Phone:419-277-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-24
Last Update Date:2023-08-16
Deactivation Date:2019-01-31
Deactivation Code:
Reactivation Date:2023-08-16
Provider Licenses
StateLicense IDTaxonomies
OH3155133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered