Healthcare Provider Details

I. General information

NPI: 1689112641
Provider Name (Legal Business Name): KRISTINE PONCE RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 HENDERSONVILLE RD
ASHEVILLE NC
28803-2868
US

IV. Provider business mailing address

119 HENDERSONVILLE RD
ASHEVILLE NC
28803-2868
US

V. Phone/Fax

Practice location:
  • Phone: 828-771-5500
  • Fax:
Mailing address:
  • Phone: 828-771-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL005016
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: