Provider Demographics
NPI:1447891882
Name:MCCORD, KRISTIN (RD, IBCLC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MCCORD
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1709
Mailing Address - Country:US
Mailing Address - Phone:937-657-3459
Mailing Address - Fax:
Practice Address - Street 1:26565 AGOURA RD STE 200
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1990
Practice Address - Country:US
Practice Address - Phone:800-998-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7552133V00000X
L-313074174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered