1033627625 NPI number — KHRYSTA ANN MARIE BAIG MSPH, RD, LDN, CHES

Table of content: KHRYSTA ANN MARIE BAIG MSPH, RD, LDN, CHES (NPI 1033627625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033627625 NPI number — KHRYSTA ANN MARIE BAIG MSPH, RD, LDN, CHES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAIG
Provider First Name:
KHRYSTA
Provider Middle Name:
ANN MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSPH, RD, LDN, CHES
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUNKEL
Provider Other First Name:
KHRYSTA
Provider Other Middle Name:
ANN MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033627625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2150 WILSON RD APT C10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37912-6070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-201-5730
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37902-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-215-3153
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  LDN0000002761 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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