Provider Demographics
NPI:1588843908
Name:BARRY, DIANNE KIMBERLY (REGISTER DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:KIMBERLY
Last Name:BARRY
Suffix:
Gender:F
Credentials:REGISTER DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85103 N YAKIMA RIVER DR
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-6189
Mailing Address - Country:US
Mailing Address - Phone:509-967-7201
Mailing Address - Fax:
Practice Address - Street 1:85103 N YAKIMA RIVER DR
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-6189
Practice Address - Country:US
Practice Address - Phone:509-967-7201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001775133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered