Provider Demographics
NPI:1497465033
Name:COWGILL, KRISTA (MS, RD, LD, IFNCP)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:COWGILL
Suffix:
Gender:F
Credentials:MS, RD, LD, IFNCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5841
Mailing Address - Country:US
Mailing Address - Phone:805-403-9354
Mailing Address - Fax:
Practice Address - Street 1:2044 WARREN RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5841
Practice Address - Country:US
Practice Address - Phone:805-403-9354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164010489133V00000X
TXDT91543133V00000X
OHLD.09055133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered