Provider Demographics
NPI:1649934878
Name:CROWLEY, KRISTEN (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CROWLEY
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 1:411 BLACK WATER RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-1725
Mailing Address - Country:US
Mailing Address - Phone:337-344-2069
Mailing Address - Fax:
Practice Address - Street 1:1921 KALISTE SALOOM RD STE 117
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6183
Practice Address - Country:US
Practice Address - Phone:337-210-5827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2933133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered