KC NUTRITION, LLC (NPI# 1689181976) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689181976 |
| Entity Type | Organization |
| Organization Name | KC NUTRITION, LLC |
| Practice Address |
1693 Sw Chandler Ave Ste 140 Bend OR 97702-3230 |
| Mailing Address |
Po Box 6232 Bend OR 97708-6232 |
| Practice Telephone | 5412793696 |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2018-01-08 |
| Authorized Official Name | KRISTINA COUGHLIN (OWNER) |
| Authorized Official Telephone | 5412793696 |
| Authorized Official Credential | MS, RDN, LD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 133N00000X | Nutritionist | 01013025 | CA | Dietary & Nutritional Service Providers |
| Y | 133V00000X | Dietitian, Registered | LD-D-10177506 | OR | Dietary & Nutritional Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEPARTMENT HEALTH AND HUMAN SERVICES | 1801333935 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | KC NUTRITION, LLC | 20748 Boulderfield Avenue, Bend, OR 97701 |
| Street Address |
1693 SW CHANDLER AVE STE 140 |
| City | BEND |
| State | OR |
| Zip Code | 97702-3230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649784224 | Kelly Christine Nottingham | Physical Therapist | 1693 Sw Chandler Ave Ste 140, Bend, OR 97702-3230 | 2017-11-19 |
| 1487161527 | Colin Chapman | Physical Therapist | 1693 Sw Chandler Ave Ste 140, Bend, OR 97702-3230 | 2018-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629676259 | Amy Michelle Anderson | Counselor | 233 Sw Wilson Ave, Ste 201, Bend, OR 97702 | 2020-10-15 |
| 1386259463 | Jacob Rehder | Counselor | 19717 Mt Batchelor Dr, #226, Bend, OR 97702 | 2020-09-15 |
| 1497385215 | Capacity Performance Therapy | Physical Medicine & Rehabilitation | 61125 Lodgepole Dr., Bend, OR 97702 | 2020-01-21 |
| 1962041707 | Shift Bend Functional Medicine | Family Medicine | 151 Sw Shevlin Hicks Dr, Suite #1, Bend, OR 97702 | 2019-12-26 |
| 1609435049 | Praxis Medical Group Inc | Orthopaedic Surgery | 1140 Sw Simpson Avenue, Suite 100, Bend, OR 97702 | 2019-06-10 |
| 1013485754 | Elana Leah Pesah | Social Worker | 138 Maaglei Harim Levin, Jerusalem, ISRAEL 97702 | 2018-11-12 |
| 1104303239 | Kyleigh Mcvey | Massage Therapist | 999 Sw Disk Dr, Bend, OR 97702 | 2018-07-21 |
| 1477042869 | Siloe Castaneda Huerta | Counselor | 1340 Nw Wall, Bend, Or, Bend, OR 97702 | 2018-05-02 |
| 1164910808 | Rebecca M Joyce | Social Worker | 1011 Sw Emkay Dr. Suite 101, Bend, OR 97702 | 2018-04-27 |
| 1093217978 | Jennifer Bury | Acupuncturist | 296 Sw Columbia St Ste D1, Bend, OR 97702 | 2018-03-06 |
| Find all providers in zip 97702 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447763479 | Makena Whitaker | Dietitian, Registered | 1253 Nw Hartford Ave Unit 2, Bend, OR 97703-2488 | 2017-11-13 |
| 1396286704 | Laura Boehm | Dietitian, Registered | 19950 Pinewood Rd, Bend, OR 97702-2020 | 2017-03-17 |
| 1801333935 | Kristina Coughlin | Dietitian, Registered | 20748 Boulderfield Ave, Bend, OR 97701-7327 | 2017-01-26 |
| 1477095370 | Brooke Kathleen Boskovich | Dietitian, Registered | 1750 Ne Neff Rd, Guest House, Bend, OR 97701-6111 | 2016-11-08 |
| 1922364348 | Kristal L. Bryant | Dietitian, Registered | 725 Ne Ross Rd, Spc 45, Bend, OR 97701-7389 | 2012-04-10 |
| 1164748000 | Lynae Adrien Smith | Dietitian, Registered | 339 Sw Century Dr Ste 201, Bend, OR 97702-1338 | 2010-04-16 |
| 1801066139 | Andrea Sue Baumann | Dietitian, Registered | 384 Sw Upper Terrace Dr Ste 213, Bend, OR 97702-3514 | 2008-03-03 |
| 1356959720 | Solera Consulting LLC | Dietitian, Registered | 235 Se Davis Ave, Bend, OR 97702-1333 | 2020-07-21 |
| 1225539174 | Lindsey Rhodes Kelly | Dietitian, Registered | 361 Ne Franklin Ave Bldg C, Bend, OR 97701-4917 | 2018-02-26 |
| 1295182079 | Kelly Harrington | Dietitian, Registered | 516 Sw 13th St, Suite 101, Bend, OR 97702-3206 | 2016-05-20 |
| Find all providers in BEND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.