Provider Demographics
NPI:1003671082
Name:KIMBRELL, MADELINE LUKE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:LUKE
Last Name:KIMBRELL
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:LUKE
Other - Last Name:LANCASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4917 GLENMERE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6807
Mailing Address - Country:US
Mailing Address - Phone:501-554-6932
Mailing Address - Fax:
Practice Address - Street 1:4917 GLENMERE RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-6807
Practice Address - Country:US
Practice Address - Phone:501-554-6932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2311133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered