Provider Demographics
NPI:1679885735
Name:LUKHARD, KIMBERLY S (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:LUKHARD
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 LYNNDALE CT STE D
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5449
Mailing Address - Country:US
Mailing Address - Phone:252-364-2917
Mailing Address - Fax:252-364-2918
Practice Address - Street 1:605 LYNNDALE CT STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5449
Practice Address - Country:US
Practice Address - Phone:252-364-2917
Practice Address - Fax:252-364-2918
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002056133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered