Healthcare Provider Details

I. General information

NPI: 1659120962
Provider Name (Legal Business Name): CHRISTINE MARIE MEDIN MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N BAYOU ST
MOBILE AL
36603-5827
US

IV. Provider business mailing address

251 N BAYOU ST
MOBILE AL
36603-5827
US

V. Phone/Fax

Practice location:
  • Phone: 251-690-8158
  • Fax:
Mailing address:
  • Phone: 251-690-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND13153
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT89040
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86145255
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number5450
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: