Provider Demographics
NPI:1326839945
Name:BRAUTIGAM, KRISTEN (RD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BRAUTIGAM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 PATRIOT WOODS CT
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9460
Mailing Address - Country:US
Mailing Address - Phone:806-549-1956
Mailing Address - Fax:
Practice Address - Street 1:9310 PATRIOT WOODS CT
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-9460
Practice Address - Country:US
Practice Address - Phone:806-549-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7219133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty