Provider Demographics
NPI:1366628463
Name:MINOGUE, KIMBERLY BETH (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BETH
Last Name:MINOGUE
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WHALEN RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1710
Mailing Address - Country:US
Mailing Address - Phone:781-724-9359
Mailing Address - Fax:
Practice Address - Street 1:148 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2505
Practice Address - Country:US
Practice Address - Phone:781-453-3016
Practice Address - Fax:781-453-3654
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2088133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469408OtherTUFTS
MAAA15809OtherHARVARD PILGRIM
MALD0145OtherBLUE CROSS BLUE SHIELD
MA469408OtherTUFTS