Provider Demographics
NPI:1720390669
Name:NIESSINK, KRISTIN LEE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:NIESSINK
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 OLD MILL LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-5100
Mailing Address - Country:US
Mailing Address - Phone:401-368-7614
Mailing Address - Fax:401-667-7339
Practice Address - Street 1:162 OLD MILL LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-5100
Practice Address - Country:US
Practice Address - Phone:401-368-7614
Practice Address - Fax:401-667-7339
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00545133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered