Healthcare Provider Details

I. General information

NPI: 1043414295
Provider Name (Legal Business Name): KRISTEEN MICHELLE DUREN RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DEXTER L WOODS MEMORIAL BLVD
WAYNESBORO TN
38485-2416
US

IV. Provider business mailing address

1604 GREEN RIVER RD
WAYNESBORO TN
38485-4928
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-5466
  • Fax: 931-722-9495
Mailing address:
  • Phone: 931-722-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number997
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: