Individual
KRISTEN ANNE TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD
Contact information
Practice address
1029 DEERWOOD STREET, COLUMBIA, SC 29205
(301) 471-2281
Mailing address
1029 DEERWOOD STREET, COLUMBIA, SC 29205
(301) 471-2281
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1004747
MD
Other
Enumeration date
08/15/2012
Last updated
08/15/2012
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