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Individual

MRS. KRISTI LYNN FOGG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, RD, LD

Contact information

Practice address
165 ASHLEY AVE, SUITE EH110, CHARLESTON, SC 29425-8905
(843) 792-8933
Mailing address
165 ASHLEY AVE, SUITE EH110, CHARLESTON, SC 29425-8905
(843) 792-8933

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
608
SC
133V00000X
Registered Dietitian
LDN00612
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
410007
HOSPITAL MEDICARE ID
RI
Enumeration date
03/28/2008
Last updated
02/17/2009
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