Provider Demographics
NPI:1689005001
Name:KIMBROUGH, KATHRYN LYN EBERT (RD, LD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYN EBERT
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LYN
Other - Last Name:EBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:2525 WALLINGWOOD DR STE 1503
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6923
Mailing Address - Country:US
Mailing Address - Phone:512-636-9441
Mailing Address - Fax:
Practice Address - Street 1:2525 WALLINGWOOD DR STE 1503
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6923
Practice Address - Country:US
Practice Address - Phone:512-798-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81250133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered