Healthcare Provider Details

I. General information

NPI: 1902119803
Provider Name (Legal Business Name): KRISTIN WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 11/04/2023
Certification Date: 11/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 CANNES CIR
AUSTIN TX
78745-3452
US

IV. Provider business mailing address

6301 CANNES CIR
AUSTIN TX
78745-3452
US

V. Phone/Fax

Practice location:
  • Phone: 512-789-9966
  • Fax: 512-789-9966
Mailing address:
  • Phone: 512-789-9966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDT06004
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT06004
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: