Provider Demographics
NPI:1508044199
Name:PURIFOY, KIMBERLY DIANE (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DIANE
Last Name:PURIFOY
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 1:8355 CRESTWAY DR
Mailing Address - Street 2:APT. 733
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3586
Mailing Address - Country:US
Mailing Address - Phone:501-908-7270
Mailing Address - Fax:
Practice Address - Street 1:8355 CRESTWAY DR
Practice Address - Street 2:APT. 733
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-3586
Practice Address - Country:US
Practice Address - Phone:501-908-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80685133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered