Provider Demographics
NPI:1811725526
Name:SPANG, KRISTEN (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SPANG
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 PALM GROVE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8250
Mailing Address - Country:US
Mailing Address - Phone:505-267-1437
Mailing Address - Fax:505-267-1437
Practice Address - Street 1:883 PALM GROVE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8250
Practice Address - Country:US
Practice Address - Phone:505-267-1437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered