Provider Demographics
NPI:1083140842
Name:MCPHERSON, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 COURT ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5446
Mailing Address - Country:US
Mailing Address - Phone:501-327-2123
Mailing Address - Fax:
Practice Address - Street 1:611 COURT ST
Practice Address - Street 2:SUITE 6
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5446
Practice Address - Country:US
Practice Address - Phone:501-327-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education