Healthcare Provider Details

I. General information

NPI: 1528099819
Provider Name (Legal Business Name): KRISTINA KUHL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BERGQUIST DR STE 1 ATTN: CREDENTIALS (CMC)
LACKLAND A F B TX
78236-9908
US

IV. Provider business mailing address

2200 BERGQUIST DR STE 1 ATTN: CREDENTIALS (CMC)
LACKLAND A F B TX
78236-9908
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-5737
  • Fax:
Mailing address:
  • Phone: 210-292-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number959609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: