Provider Demographics
NPI:1659193696
Name:HARRIS, KRISTIN (FDN-P, NC)
Entity type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FDN-P, NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MERLOT DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-8281
Mailing Address - Country:US
Mailing Address - Phone:408-499-6808
Mailing Address - Fax:
Practice Address - Street 1:360 MERLOT DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-8281
Practice Address - Country:US
Practice Address - Phone:408-499-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education