Provider Demographics
NPI:1265111959
Name:MCCARTHY, KRISTINA MARIE (MCN, RD, LD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MCN, RD, LD
Other - Prefix:
Other - First Name:KRISSY
Other - Middle Name:
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MCN, RD, LD
Mailing Address - Street 1:11925 SNOW FINCH RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-3307
Mailing Address - Country:US
Mailing Address - Phone:810-348-7491
Mailing Address - Fax:
Practice Address - Street 1:4501 SPICEWOOD SPRINGS RD STE 1022
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8543
Practice Address - Country:US
Practice Address - Phone:512-257-0898
Practice Address - Fax:512-792-9912
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85649133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered