Individual
KRISTY DERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,RD,LD,CNSC
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(210) 355-9018
Mailing address
1820 BETH DR, LONGVIEW, TX 75605-2441
(210) 355-9018
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT0692
TX
Other
Enumeration date
04/04/2023
Last updated
02/27/2024
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