Provider Demographics
NPI:1619433620
Name:KIMBERLY EVANS RD
Entity Type:Organization
Organization Name:KIMBERLY EVANS RD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD
Authorized Official - Phone:802-578-6975
Mailing Address - Street 1:68 FOLSHAM HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5613
Mailing Address - Country:US
Mailing Address - Phone:802-578-6975
Mailing Address - Fax:
Practice Address - Street 1:68 FOLSHAM HOLLOW RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5613
Practice Address - Country:US
Practice Address - Phone:802-578-6975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty