Healthcare Provider Details

I. General information

NPI: 1104547793
Provider Name (Legal Business Name): KRISTEN ANNE WILLIAMSON RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KRISTEN ANNE MCKINLEY

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 1ST ST S
WILLMAR MN
56201-4243
US

IV. Provider business mailing address

1703 16TH ST NW
WILLMAR MN
56201-6001
US

V. Phone/Fax

Practice location:
  • Phone: 320-240-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number3666
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: