Provider Demographics
NPI:1538281365
Name:WERNEL, KIMBERLY A (RD, LD,CDE)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:WERNEL
Suffix:
Gender:F
Credentials:RD, LD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12140 NALL AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2503
Mailing Address - Country:US
Mailing Address - Phone:913-451-8500
Mailing Address - Fax:913-451-8575
Practice Address - Street 1:12140 NALL AVE
Practice Address - Street 2:STE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2503
Practice Address - Country:US
Practice Address - Phone:913-451-8500
Practice Address - Fax:913-451-8575
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001008180133V00000X
KS1100133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered