Provider Demographics
NPI:1063643658
Name:SOWELL, KIMBERLY HOLT (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:HOLT
Last Name:SOWELL
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-6227
Mailing Address - Country:US
Mailing Address - Phone:901-496-2041
Mailing Address - Fax:
Practice Address - Street 1:8592 RICKY BELL CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4197
Practice Address - Country:US
Practice Address - Phone:901-380-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000001939133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered