Provider Demographics
NPI:1700940947
Name:KESTERSON, KRISTIN E (RD, LMNT, CDE)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:E
Last Name:KESTERSON
Suffix:
Gender:F
Credentials:RD, LMNT, CDE
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:E
Other - Last Name:MORTENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1116 MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2603
Mailing Address - Country:US
Mailing Address - Phone:308-762-5766
Mailing Address - Fax:
Practice Address - Street 1:2101 BOX BUTTE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-4445
Practice Address - Country:US
Practice Address - Phone:308-762-6660
Practice Address - Fax:308-762-1923
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE606133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
275405Medicare ID - Type Unspecified