Individual provider Active NPI

Kristin Jo Davis Lesh, RD

  • Registered Dietitian
  • Longview, WA
National Provider Identifier
1720371354
Registry record updated Jan 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DI60209738 Issued in WA
Practice address
1615 Delaware St
Longview, WA 98632-2367
Phone
(360) 501-3601
Fax
(360) 501-3648
NPI assigned
May 16, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 1042 OR
Registered Dietitian 133V00000X DI60209738 WA Primary

Addresses

Primary practice location

1615 Delaware St
Longview, WA 98632-2367

Mailing address

1115 SE 164TH Ave
Dept. 358
Vancouver, WA 98683-9324
Phone (360) 729-1462

Other names 1

  • Kristin Jo Davis Former name

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

State licenses

LicenseStateTypeSpecialty
1042ORMDRegistered Dietitian
DI60209738WAMDRegistered Dietitian

NPI Registry JSON

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

{
    "created_epoch": "1305504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451952000000",
    "number": "1720371354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 SE 164TH AVE",
            "address_2": "DEPT. 358",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839324",
            "telephone_number": "360-729-1462",
            "fax_number": "360-729-3104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322367",
            "telephone_number": "360-501-3601",
            "fax_number": "360-501-3648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS LESH",
        "first_name": "KRISTIN",
        "middle_name": "JO",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-16",
        "last_updated": "2016-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "1042",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "DI60209738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "DAVIS",
            "middle_name": "JO",
            "credential": "RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2016; 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.