Healthcare Provider Details

I. General information

NPI: 1609342351
Provider Name (Legal Business Name): KRISTEN KEEN RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2018
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 VINE ST
CINCINNATI OH
45202-1141
US

IV. Provider business mailing address

PO BOX 830242
PHILADELPHIA PA
19182-0242
US

V. Phone/Fax

Practice location:
  • Phone: 855-699-6937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-1164
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.007931
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3080
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT86292
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number285809
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN0000002835
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: