MEDICARE: KV TOTAL NUTRITION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DI100000720	DC

General Provider Information

NPI Number	:	1124409396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KV TOTAL NUTRITION LLC

Provider Business Mailing Address
First Line	:	1011 1ST ST SE
Second Line	:	APT 914
City	:	WASHINGTON
State	:	DC
Zip	:	20003-3392
Country	:	US
Telephone Number	:	512-590-1585
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 1ST ST SE
Second Line	:	APT 914
City	:	WASHINGTON
State	:	DC
Zip	:	20003-3392
Country	:	US
Telephone Number	:	512-590-1585
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	KRISTINA VERA
Credential	:	RD
Telephone Number	:	512-590-1585

Provider Enumeration Date	:	06/14/2015
Last Update Date	:	06/14/2015

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Directions to “KV TOTAL NUTRITION LLC ” Practice Location

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