Provider Demographics
NPI:1750179255
Name:COATES, KIERSTEN (RD)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:
Last Name:COATES
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BROOKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1204
Mailing Address - Country:US
Mailing Address - Phone:215-839-8151
Mailing Address - Fax:866-640-2175
Practice Address - Street 1:153 BROOKSHIRE DR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1204
Practice Address - Country:US
Practice Address - Phone:215-839-8151
Practice Address - Fax:866-640-2175
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered