Provider Demographics
NPI:1598964983
Name:EDWARDS, KIMBERLY FUNDERBURK (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:FUNDERBURK
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N THISTLE LN
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3801
Mailing Address - Country:US
Mailing Address - Phone:407-399-1610
Mailing Address - Fax:407-647-7694
Practice Address - Street 1:820 N THISTLE LN
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-3801
Practice Address - Country:US
Practice Address - Phone:407-399-1610
Practice Address - Fax:407-647-7694
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL565133V00000X, 133VN1005X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education