Provider Demographics
NPI:1811144462
Name:GARRON, KRISTEN (RD, CDE, LDN)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GARRON
Suffix:
Gender:F
Credentials:RD, CDE, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-2826
Mailing Address - Country:US
Mailing Address - Phone:610-996-9660
Mailing Address - Fax:
Practice Address - Street 1:2505 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-2826
Practice Address - Country:US
Practice Address - Phone:610-996-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003823133N00000X
133NN1002X
PA994257133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education