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General NPI Number Information
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NPI Number | 1316528664
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Entity Type | Individual
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Provider Name | KRISTEN ELIZABETH SHIVES RDN, LD
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Gender | Female
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 411 PARK GROVE DR STE 720
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City | KATY
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State | TX
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Zip | 77450-1577
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Country | US
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Telephone | 713-997-9613
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Fax |
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Provider Business Mailing Address
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Address Line | 3232 LAUREL BEND LN
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City | PEARLAND
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State | TX
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Zip | 77584-4569
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Country | US
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Telephone | 240-291-8481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86102056
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License Number State |
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