Provider Demographics
NPI:1346205994
Name:ORBEN, KIMBERLEE
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:ORBEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:BALLANTYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:660 ACKERMAN 3RD FLOOR
Mailing Address - Street 2:PO BOX 183103
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-3103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:452 WEST TENTH AVENUE
Practice Address - Street 2:G1008
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-4299
Practice Address - Fax:614-293-2667
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRD5431133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBAMT02881Medicare PIN