Provider Demographics
NPI:1821746322
Name:MICHAUD, KRISTOPHER ALAN HAINES (MS, RD, LD)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:ALAN HAINES
Last Name:MICHAUD
Suffix:
Gender:M
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7021
Mailing Address - Country:US
Mailing Address - Phone:207-467-8810
Mailing Address - Fax:207-467-8811
Practice Address - Street 1:72 MAIN ST
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7021
Practice Address - Country:US
Practice Address - Phone:207-467-8810
Practice Address - Fax:207-467-8811
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1712133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered