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NPI Code Detail

MEDICARE: KMM NUTRITION CONSULTING

MEDICARE: KMM NUTRITION CONSULTING
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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1760997274
Entity Type Code : Organization
Provider Name (Legal Business Name) : KMM NUTRITION CONSULTING
Provider Business Mailing Address
First Line : 6950 OAK VALLEY LN
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80919-1513
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9320 GRAND CORDERA PKWY STE 100
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80924-7004
Country : US
Telephone Number : 719-344-2780
Fax Number :
Authorized Official
Title or Position : REGISTERED DIETITIAN NUTRITIONIST
Name : KIRSTEN MATHESON
Credential : RDN, CDE
Telephone Number : 719-964-1429
Provider Enumeration Date : 12/06/2017
Last Update Date : 12/06/2017

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Directions to “KMM NUTRITION CONSULTING ” Practice Location

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