Provider Demographics
NPI:1396840732
Name:CLOYD, KIMBERLY GAIL (RD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:GAIL
Last Name:CLOYD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 EVERETT LN
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-9520
Mailing Address - Country:US
Mailing Address - Phone:270-886-3494
Mailing Address - Fax:270-707-0780
Practice Address - Street 1:210A BURLEY AVENUE
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240
Practice Address - Country:US
Practice Address - Phone:270-889-0282
Practice Address - Fax:270-887-8340
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0548133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0548OtherLICENSE #
708255OtherDIETETIC REGISTRATION #
KY0548OtherLICENSE #