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General NPI Number Information
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NPI Number | 1760997274
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Entity Type | Organization
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Legal Business Name | KMM NUTRITION CONSULTING
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 9320 GRAND CORDERA PKWY STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80924-7004
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Country | US
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Telephone | 719-344-2780
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Fax |
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Provider Business Mailing Address
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Address Line | 6950 OAK VALLEY LN
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-1513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN NUTRITIONIST
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Name | KIRSTEN MATHESON
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Credential | RDN, CDE
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Telephone | 719-964-1429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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