Provider Demographics
NPI:1649872664
Name:KNUF-CLEMENTS, KRISTEN (RD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KNUF-CLEMENTS
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 1:1355 DAVIDSON WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3142
Mailing Address - Country:US
Mailing Address - Phone:775-250-9518
Mailing Address - Fax:
Practice Address - Street 1:75 PRINGLE WAY STE 505
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1469
Practice Address - Country:US
Practice Address - Phone:775-982-5437
Practice Address - Fax:775-982-3895
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32958-DI-3133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered