Provider Demographics
NPI:1205973930
Name:PRIORE, KRISTEN (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:PRIORE
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LD
Mailing Address - Street 1:109 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO VIEJO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9726
Mailing Address - Country:US
Mailing Address - Phone:956-365-1905
Mailing Address - Fax:956-365-1875
Practice Address - Street 1:5501 S EXPRESSWAY 77
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3213
Practice Address - Country:US
Practice Address - Phone:956-365-1905
Practice Address - Fax:956-365-1875
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06677133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered