MEDICARE: HEATHER KLINGENSMITH RD

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
1	133V00000X	Registered Dietitian	86035124	CO

General Provider Information

NPI Number	:	1265205389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER KLINGENSMITH RD

Provider Business Mailing Address
First Line	:	3318 SANTA FE CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-4240
Country	:	US
Telephone Number	:	719-287-1645
Fax Number	:

Provider Business Practice Location Address
First Line	:	3318 SANTA FE CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-4240
Country	:	US
Telephone Number	:	719-287-1645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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