Provider Demographics
NPI:1609814805
Name:MOSSBURG, KIMBERLY HALL (RD, ATC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HALL
Last Name:MOSSBURG
Suffix:
Gender:F
Credentials:RD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 KILLDEER DR
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46936-1383
Mailing Address - Country:US
Mailing Address - Phone:765-628-0806
Mailing Address - Fax:
Practice Address - Street 1:1118 KILLDEER DR
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:IN
Practice Address - Zip Code:46936-1383
Practice Address - Country:US
Practice Address - Phone:765-628-0806
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered