Provider Demographics
NPI:1649602814
Name:BROWN, KRISTEN L (MS, RD, LDN)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 ELLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1102
Mailing Address - Country:US
Mailing Address - Phone:704-336-7207
Mailing Address - Fax:
Practice Address - Street 1:3500 ELLINGTON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1102
Practice Address - Country:US
Practice Address - Phone:704-336-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001978133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered