Healthcare Provider Details

I. General information

NPI: 1164497400
Provider Name (Legal Business Name): KRISTEN CARNEY R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 CENTER ST
BERKELEY CA
94704-1138
US

IV. Provider business mailing address

1907 CENTER ST
BERKELEY CA
94704-1127
US

V. Phone/Fax

Practice location:
  • Phone: 510-486-1424
  • Fax:
Mailing address:
  • Phone: 510-486-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number810511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: