Healthcare Provider Details

I. General information

NPI: 1154160976
Provider Name (Legal Business Name): CHRISTINIA KIRK REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 130TH AVE NE
BELLEVUE WA
98005-3329
US

IV. Provider business mailing address

233 130TH AVE NE
BELLEVUE WA
98005-3329
US

V. Phone/Fax

Practice location:
  • Phone: 480-390-4341
  • Fax:
Mailing address:
  • Phone: 480-390-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number61149573
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: