Provider Demographics
NPI:1316401920
Name:KIMBROUGH NUTRITION, LLC
Entity Type:Organization
Organization Name:KIMBROUGH NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:512-798-3491
Mailing Address - Street 1:2525 WALLINGWOOD DR BLDG 1503
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6923
Mailing Address - Country:US
Mailing Address - Phone:512-798-3491
Mailing Address - Fax:
Practice Address - Street 1:2525 WALLINGWOOD DR BLDG 1503
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6923
Practice Address - Country:US
Practice Address - Phone:512-798-3491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty