Provider Demographics
NPI:1467080580
Name:CHAPMAN, KIMBERLY MARIE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 PINE RIDGE PT
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-4241
Mailing Address - Country:US
Mailing Address - Phone:601-248-1687
Mailing Address - Fax:
Practice Address - Street 1:312 PINE RIDGE PT
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-4241
Practice Address - Country:US
Practice Address - Phone:601-248-1687
Practice Address - Fax:888-820-5115
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
807390133V00000X
WI3100-29133V00000X
WV877133V00000X
PADN004869133V00000X
TNLDN0000001995133V00000X
DCDII00000537133V00000X
SC663133V00000X
OK2081133V00000X
IDD-1067133V00000X
NMLD-1282133V00000X
AL1557133V00000X
LA2080133V00000X
KS1778133V00000X
KY123431133V00000X
MSD0958133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered