Healthcare Provider Details

I. General information

NPI: 1356068589
Provider Name (Legal Business Name): SIERRA RAVEN KIRBY MPH, RD, LDN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 LEXINGTON AVE
NEW YORK NY
10022-1200
US

IV. Provider business mailing address

3732 LAKESIDE DR STE 200
RENO NV
89509-4519
US

V. Phone/Fax

Practice location:
  • Phone: 800-207-1897
  • Fax:
Mailing address:
  • Phone: 775-360-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number39504-DI-2
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: