Healthcare Provider Details

I. General information

NPI: 1528300589
Provider Name (Legal Business Name): KRISTINE YVETTE TAYLOR MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 COVE ST
PORTLAND ME
04101-2514
US

IV. Provider business mailing address

52 COVE ST
PORTLAND ME
04101-2514
US

V. Phone/Fax

Practice location:
  • Phone: 207-358-0154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI1407
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2796
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: