Krystle Clark, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1012724 Issued in MI

Practice address

800 E Milham Ave
Portage, MI 49002-1490

Phone

(269) 888-6813

NPI assigned

Aug 3, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1627948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1699449694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 CAMBRIDGE DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490014406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E MILHAM AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490021490",
            "telephone_number": "269-888-6813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KRYSTLE",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-03",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MI",
            "license": "1012724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corinne Renee Clancy Graber, LMFT
• Ashley Clandening
• Emily Clarey
• Cheyann Clark
• Kimberly Carol Clark, B.S. CMT
• Nautica Clark
• Tawanda Clarke, M.A., LPC, CAADC
• Michael Maurice Claussen, PA-C
• Kimberly Clawson
• Krista Anne Climer

• Registered Dietitian in Portage, MI
• Providers in Portage, MI by specialty
• Registered Dietitian in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.