Doctor Name: | MRS. KRISTEL JUNE FREDERICKS |
NPI Number: | 1003191735 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, RD, LD |
License Number: | DT82118 |
Business Practice Address: | 3133 Good Shepherd Way Longview, TX - 756057921 |
Business Phone Number: | 9033236541 |
Business Fax Number: | 9033236564 |
Mailing Address: | 3133 Good Shepherd Way, LONGVIEW |
State: | TX |
Postal Code: | 756057921 |
Phone Number: | 9033236541 |
Fax Number: | 9033236564 |
NPI Enumeration Date: | 10/13/2011 |
NPI Last Update Date: | 07/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | DT82118 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |