Provider Demographics
NPI:1669268371
Name:GONZALEZ-PETTY, KRISTINA CORAL (RDN, LD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:CORAL
Last Name:GONZALEZ-PETTY
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 1:617 GEOGHEGAN RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-7023
Mailing Address - Country:US
Mailing Address - Phone:270-312-5984
Mailing Address - Fax:
Practice Address - Street 1:617 GEOGHEGAN RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-7023
Practice Address - Country:US
Practice Address - Phone:270-312-5984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY297230133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered