Individual
KRYSTLE LEIGH BLUNK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
620 E MONROE ST, MEXICO, MO 65265-2919
(573) 582-8351
(573) 582-3335
Mailing address
1121 DANFORTH DR, COLUMBIA, MO 65201-6231
(417) 631-9897
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1011685
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1011685
COMMISSION ON DIETETIC REGISTRATION
MO
Enumeration date
09/28/2011
Last updated
10/08/2012
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