Provider Demographics
NPI:1659158988
Name:LIVING WELL WITH KB LLC
Entity Type:Organization
Organization Name:LIVING WELL WITH KB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:SUZANNA
Authorized Official - Last Name:BROCKMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:757-869-0236
Mailing Address - Street 1:504 ALLEN HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-4882
Mailing Address - Country:US
Mailing Address - Phone:757-869-0236
Mailing Address - Fax:
Practice Address - Street 1:6831 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-4805
Practice Address - Country:US
Practice Address - Phone:757-869-0236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty