Provider Demographics
NPI:1649089434
Name:TALLEY, KRISTEN (RDN, LD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:TALLEY
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 LAKECREST CIR STE 400-117
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1937
Mailing Address - Country:US
Mailing Address - Phone:859-285-6485
Mailing Address - Fax:
Practice Address - Street 1:424 LEWIS HARGETT CIR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3688
Practice Address - Country:US
Practice Address - Phone:859-285-6485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY123243133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered