Provider Demographics
NPI:1891096863
Name:DECKER, KRISTEN K (RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:K
Last Name:DECKER
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 1:24086 BOWENS PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52310-8101
Mailing Address - Country:US
Mailing Address - Phone:319-480-8296
Mailing Address - Fax:
Practice Address - Street 1:24086 BOWENS PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-8101
Practice Address - Country:US
Practice Address - Phone:319-480-8296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83631133V00000X
IA001944133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1891096863OtherNPI
IA001944OtherIOWA DIETETIC LICENSURE
TX1891096863OtherNPI