Provider Demographics
NPI:1558098806
Name:CORREA, KIMBERLY (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CORREA
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 SILVERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9240
Mailing Address - Country:US
Mailing Address - Phone:336-829-4085
Mailing Address - Fax:
Practice Address - Street 1:2415 PENNY RD STE 202
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8123
Practice Address - Country:US
Practice Address - Phone:336-829-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered