Provider Demographics
NPI:1649406885
Name:KEEN, KRISTIN L (RD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:KEEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:L
Other - Last Name:KEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:3894 VALENCIA RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-9222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 UNIVERSITY BLVD N
Practice Address - Street 2:SUITE 606
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-9203
Practice Address - Country:US
Practice Address - Phone:904-253-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5503133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered