Individual provider Active NPI

Kristen Wollmuth, RD

  • Registered Dietitian
  • Gonzales, TX
National Provider Identifier
1508647710
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
86144109 Issued in NU
Practice address
1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311
Phone
(830) 672-7581
Fax
(830) 672-2401
NPI assigned
Oct 12, 2023
Last updated
Oct 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 86144109 NU Primary

Addresses

Primary practice location

1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311

Mailing address

PO Box 587
Gonzales, TX 78629-0587
Phone (830) 672-7581

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240105002287 TX Practitioner - Registered Dietitian Or Nutrition Professional 2668823485 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sparkman Nutrition, LLC Dietitian, Registered CurrentSince Oct 4, 2025 Accepting new patients
Wilfong Nutrition Limited Liability Company Dietitian, Registered Past Accepting new patients
Gonzales Healthcare Systems Past Accepting new patients

Locations

4501 Spicewood Springs Rd
Ste 1022
Austin, TX 78759
Phone (512) 257-0898

7701 N Lamar Blvd
Ste 402
Austin, TX 78752
Phone (512) 257-0898

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1508647710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 587",
            "city": "GONZALES",
            "state": "TX",
            "postal_code": "786290587",
            "telephone_number": "830-672-7581",
            "fax_number": "830-672-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 N SARAH DEWITT DR",
            "city": "GONZALES",
            "state": "TX",
            "postal_code": "786293311",
            "telephone_number": "830-672-7581",
            "fax_number": "830-672-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLMUTH",
        "first_name": "KRISTEN",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-12",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": "86144109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gonzales, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.