MEDICARE: JULIANNE KOENIGSBERG

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

General Provider Information

NPI Number	:	1730899436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNE KOENIGSBERG

Provider Business Mailing Address
First Line	:	3333 OAKWELL CT APT 627
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-3056
Country	:	US
Telephone Number	:	814-341-1752
Fax Number	:

Provider Business Practice Location Address
First Line	:	47TH STREET AND KENTUCKY AVE BLDG 3219
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223
Country	:	US
Telephone Number	:	270-461-3892
Fax Number	:

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

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	06/22/2026

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