Provider Demographics
NPI:1447589403
Name:NANNINGA, KIMBERLY ANN (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:NANNINGA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 JORDAN CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5876
Mailing Address - Country:US
Mailing Address - Phone:515-223-7389
Mailing Address - Fax:515-221-9355
Practice Address - Street 1:1725 JORDAN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5876
Practice Address - Country:US
Practice Address - Phone:515-223-7389
Practice Address - Fax:515-221-9355
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001905133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered