Provider Demographics
NPI:1740665736
Name:RAINES, KRYSTAL A (RDN, LDN)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:A
Last Name:RAINES
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:ROSMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28772-0795
Mailing Address - Country:US
Mailing Address - Phone:828-553-9263
Mailing Address - Fax:
Practice Address - Street 1:600 BEVERLY HANKS CTR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2305
Practice Address - Country:US
Practice Address - Phone:828-693-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004360133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered