Healthcare Provider Details

I. General information

NPI: 1851779532
Provider Name (Legal Business Name): KRISTA KOHLS M.S., R.D., C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W BELTLINE HWY SUITE NUMBER 207
MADISON WI
53713-2318
US

IV. Provider business mailing address

5795 WINDSONA CIR
FITCHBURG WI
53711-5839
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-6102
  • Fax:
Mailing address:
  • Phone: 608-417-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2108-029
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: