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NPI Code Detail

MEDICARE: MRS. KRISTEEN MICHELLE DUREN RD, LDN

MEDICARE: MRS. KRISTEEN MICHELLE DUREN RD, LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian997TN

General Provider Information

NPI Number : 1043414295
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTEEN MICHELLE DUREN RD, LDN
Provider Business Mailing Address
First Line : 1604 GREEN RIVER RD
Second Line :
City : WAYNESBORO
State : TN
Zip : 38485-4928
Country : US
Telephone Number : 931-722-2820
Fax Number :
Provider Business Practice Location Address
First Line : 215 DEXTER L WOODS MEMORIAL BLVD
Second Line :
City : WAYNESBORO
State : TN
Zip : 38485-2416
Country : US
Telephone Number : 931-722-5466
Fax Number : 931-722-9495
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2007
Last Update Date : 07/08/2007

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