Provider Demographics
NPI:1538124862
Name:KIMBERLIN, DEBBIE A (RD)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:A
Last Name:KIMBERLIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:A
Other - Last Name:DION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-1137
Mailing Address - Country:US
Mailing Address - Phone:815-922-0660
Mailing Address - Fax:
Practice Address - Street 1:500 W COURT ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3661
Practice Address - Country:US
Practice Address - Phone:815-937-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK26168Medicare ID - Type Unspecified