Active NPI
Kristen Renee Kistler, MS, RD, LDN
- Registered Dietitian
- Raleigh, NC
National Provider Identifier
1336789064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L005868
- Practice address
- 4207 Lake Boone TRL Ste 100
Raleigh, NC 27607-6685 - Phone
- (919) 784-7874
- NPI assigned
- Jan 10, 2020
- 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 | L005868 | NC | Primary |
Addresses
Primary practice location
4207 Lake Boone TRL Ste 100
Raleigh, NC 27607-6685
Mailing address
4207 Lake Boone TRL Ste 100
Raleigh, NC 27607-6685
Phone (919) 784-7874
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 |
|---|---|---|---|
| L005868 | NC | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rex Hospital Inc | Past | Accepting new patients | |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba North Carolina Heart and Vascular
- Cardiovascular Disease Physician
- Raleigh, NC
- NPI 1972939643
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676505600000",
"number": "1336789064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4207 LAKE BOONE TRL STE 100",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276076685",
"telephone_number": "919-784-7874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4207 LAKE BOONE TRL STE 100",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276076685",
"telephone_number": "919-784-7874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISTLER",
"first_name": "KRISTEN",
"middle_name": "RENEE",
"credential": "MS, RD, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-10",
"last_updated": "2023-02-16",
"certification_date": "2023-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L005868",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.