Provider Demographics
NPI:1598198178
Name:LETT, KIMBERLY (RDN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LETT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3257 WINDY WOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-6046
Mailing Address - Country:US
Mailing Address - Phone:321-430-5992
Mailing Address - Fax:
Practice Address - Street 1:3257 WINDY WOOD DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-6046
Practice Address - Country:US
Practice Address - Phone:321-430-5992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000001812133V00000X
FLND6387133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered