Provider Demographics
NPI:1144859216
Name:COLEMAN, KRISTEN ANNE (RD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANNE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N. FRESNO SUITE 370
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701
Mailing Address - Country:US
Mailing Address - Phone:559-459-4543
Mailing Address - Fax:559-459-1539
Practice Address - Street 1:215 N. FRESNO SUITE 370
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-9370
Practice Address - Country:US
Practice Address - Phone:559-459-4543
Practice Address - Fax:559-459-1539
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0997840133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric