Healthcare Provider Details

I. General information

NPI: 1538669585
Provider Name (Legal Business Name): KRISTEN FITZSIMMONS MS, RD, LDN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 BELMONT ST
WORCESTER MA
01604-1019
US

IV. Provider business mailing address

403 BELMONT ST
WORCESTER MA
01604-1019
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-0104
  • Fax:
Mailing address:
  • Phone: 508-856-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4329
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: