Provider Demographics
NPI:1881039030
Name:MIDDLETON, KRISTEN (RD, CSP, LD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:RD, CSP, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 HARPER ST
Mailing Address - Street 2:BP-3252
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0012
Mailing Address - Country:US
Mailing Address - Phone:706-721-2389
Mailing Address - Fax:
Practice Address - Street 1:1446 HARPER ST
Practice Address - Street 2:BP-3252
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0012
Practice Address - Country:US
Practice Address - Phone:706-721-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA949651133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric