Krista Faircloth Kellum, RDN, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LDN0000003477 Issued in TN

Practice address

2504 Prairie Hill Dr
Antioch, TN 37013-3682

Phone

(912) 294-7630

NPI assigned

Jul 5, 2023

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

Other names 1

• Krist Lauren Faircloth Former name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Sarah Lynn Nutrition

  • Registered Dietitian
  • Camillus, NY
  • NPI 1730851346

  Dietitian, Registered

  Medicare reassignment NPD
• Lindatroia,LCSW, P.C.

  • Clinical Social Worker
  • Camillus, NY
  • NPI 1780740688
  NPD (past)

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

{
    "created_epoch": "1688515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1891473492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2504 PRAIRIE HILL DR",
            "city": "ANTIOCH",
            "state": "TN",
            "postal_code": "370133682",
            "telephone_number": "912-294-7630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2504 PRAIRIE HILL DR",
            "city": "ANTIOCH",
            "state": "TN",
            "postal_code": "370133682",
            "telephone_number": "912-294-7630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLUM",
        "first_name": "KRISTA",
        "middle_name": "FAIRCLOTH",
        "credential": "RDN, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-05",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TN",
            "license": "LDN0000003477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRIST",
            "last_name": "FAIRCLOTH",
            "middle_name": "LAUREN",
            "credential": "RDN, LDN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Karlene Guasteferro DDS of Tennessee PC
• Karlene Guasteferro, D.D.S. of Arkansas, P.C.
• Karlene Guasteferro, D.D.S. of Maine, P.C.
• Tahir Kedir
• Robert Lee Kelley III, OTR/L
• Reshonda Kelly
• Kendra Taylor Nutrition, LLC
• Mia Christian Broughton Kendricks
• Shabeen Adeel Khan
• Elvin Jelimo Kibet

• Registered Dietitian in Antioch, TN
• Providers in Antioch, TN by specialty
• Registered Dietitian in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.