Provider Demographics
NPI:1780951483
Name:KOELLE, KRISTY (RD, LDN, CDE, CSG)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:KOELLE
Suffix:
Gender:F
Credentials:RD, LDN, CDE, CSG
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:OLMSTED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN, CDE, CSG
Mailing Address - Street 1:1800 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6709
Mailing Address - Country:US
Mailing Address - Phone:814-231-7116
Mailing Address - Fax:814-231-7118
Practice Address - Street 1:1800 E PARK AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6709
Practice Address - Country:US
Practice Address - Phone:814-231-7116
Practice Address - Fax:814-231-7118
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003908133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered