Organization
KC NUTRITION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINA COUGHLIN MS, RDN, LD (OWNER)
(541) 279-3696
Entity
Organization
Contact information
Practice address
1693 SW CHANDLER AVE STE 140, BEND, OR 97702-3230
(541) 279-3696
Mailing address
PO BOX 6232, BEND, OR 97708-6232
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
01013025
CA
133V00000X
Registered Dietitian
Primary
LD-D-10177506
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801333935
DEPARTMENT HEALTH AND HUMAN SERVICES
—
Enumeration date
01/08/2018
Last updated
01/08/2018
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