Provider Demographics
NPI:1457710105
Name:KOCHENOUR, KRISTEN (RD)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:KOCHENOUR
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 1:3740 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2501
Mailing Address - Country:US
Mailing Address - Phone:610-541-2851
Mailing Address - Fax:855-813-0235
Practice Address - Street 1:3740 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2501
Practice Address - Country:US
Practice Address - Phone:610-541-2851
Practice Address - Fax:855-813-0235
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005623133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered