Active NPI
Kristel June Fredericks, MS, RD, LD
- Registered Dietitian
- Longview, TX
National Provider Identifier
1003191735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT82118
- Practice address
- 3133 Good Shepherd Way
Longview, TX 75605-7921 - Phone
- (903) 323-6541
- Fax
- (903) 323-6564
- NPI assigned
- Oct 13, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT82118 | TX | Primary |
Addresses
Primary practice location
3133 Good Shepherd Way
Longview, TX 75605-7921
Mailing address
3133 Good Shepherd Way
Longview, TX 75605-7921
Phone (903) 323-6541
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT82118 | TX | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MNT Associates LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375228800000",
"number": "1003191735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3133 GOOD SHEPHERD WAY",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756057921",
"telephone_number": "903-323-6541",
"fax_number": "903-323-6564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3133 GOOD SHEPHERD WAY",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756057921",
"telephone_number": "903-323-6541",
"fax_number": "903-323-6564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICKS",
"first_name": "KRISTEL",
"middle_name": "JUNE",
"name_prefix": "Mrs.",
"credential": "MS, RD, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-13",
"last_updated": "2013-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT82118",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.