Provider Demographics
NPI:1245501584
Name:WATTS, KIRSTEN RENEE (DIPACLM, MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:RENEE
Last Name:WATTS
Suffix:
Gender:F
Credentials:DIPACLM, MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 QUINCY ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:505-917-5547
Practice Address - Street 1:1023 QUINCY ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3511
Practice Address - Country:US
Practice Address - Phone:505-917-5547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0719133V00000X
NM953636133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered