Provider Demographics
NPI:1134324619
Name:WILKERSON, KIMBERLY GARRETT (RD, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:GARRETT
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 RICHMOND DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5995
Mailing Address - Country:US
Mailing Address - Phone:970-204-0300
Mailing Address - Fax:970-226-9041
Practice Address - Street 1:3519 RICHMOND DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5995
Practice Address - Country:US
Practice Address - Phone:970-204-0300
Practice Address - Fax:970-226-9041
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
632685OtherADA REGISTERED DIETITIAN
TXDT80452OtherTEXAS DIETITIAN LICENSE
CO187347OtherCERTIFIED DIABETES EDUCATOR