Provider Demographics
NPI:1952182925
Name:RACE, KRISTEN (RD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:RACE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10121 CARDINAL VIEW PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6921
Mailing Address - Country:US
Mailing Address - Phone:702-882-7191
Mailing Address - Fax:
Practice Address - Street 1:10121 CARDINAL VIEW PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6921
Practice Address - Country:US
Practice Address - Phone:702-882-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39558-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered