Basic Information
| Provider Information | |||||||||
| NPI: | 1053486910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINTON | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | ROLAND | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, RD, CD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6116 NE 188TH PL | ||||||||
| Address2: | |||||||||
| City: | KENMORE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980283212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254830903 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10501 MERIDIAN AVE N | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981339509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062964990 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DI00000810 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 8270084 | 05 | WA | MEDICAID |