Provider Demographics
NPI:1548752694
Name:GEIRINGER, KIM S
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:S
Last Name:GEIRINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11074 NW 61ST COURT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076
Mailing Address - Country:US
Mailing Address - Phone:917-266-2501
Mailing Address - Fax:
Practice Address - Street 1:11074 NW 61ST CT
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076
Practice Address - Country:US
Practice Address - Phone:172-662-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
814486133V00000X
FLND7896133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty