Provider Demographics
NPI:1780389403
Name:QUISENBERRY, KRISTEN M K (RD, LD, CNSC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M K
Last Name:QUISENBERRY
Suffix:
Gender:F
Credentials:RD, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 SCOTTS CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4769
Mailing Address - Country:US
Mailing Address - Phone:843-670-8093
Mailing Address - Fax:
Practice Address - Street 1:1221 HIDDEN LAKES DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9467
Practice Address - Country:US
Practice Address - Phone:843-872-2090
Practice Address - Fax:866-421-3337
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC377133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered