Healthcare Provider Details

I. General information

NPI: 1356206825
Provider Name (Legal Business Name): KRISTEN EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NICKERSON ST STE 300
SEATTLE WA
98109-1699
US

IV. Provider business mailing address

1295 BANDANA BLVD N STE 210
SAINT PAUL MN
55108-5115
US

V. Phone/Fax

Practice location:
  • Phone: 888-364-5977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI70068348
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: