MEDICARE: MRS. KRISTA KAY GRINSTEAD R.D.

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	133VN1005X	Renal Nutrition Registered Dietitian	1024	OK

General Provider Information

NPI Number	:	1477576320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTA KAY GRINSTEAD R.D.

Provider Business Mailing Address
First Line	:	3500 STATE ST
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2932
Country	:	US
Telephone Number	:	918-331-1770
Fax Number	:	918-331-1328

Provider Business Practice Location Address
First Line	:	3500 STATE ST
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2932
Country	:	US
Telephone Number	:	918-331-1770
Fax Number	:	918-331-1328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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