Provider Demographics
NPI:1710547682
Name:KIRSCHNER, KIMBERLY (LDN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KIRSCHNER
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 OAK SHADOWS RD
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4240
Mailing Address - Country:US
Mailing Address - Phone:305-926-7982
Mailing Address - Fax:
Practice Address - Street 1:743 OAK SHADOWS RD
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4240
Practice Address - Country:US
Practice Address - Phone:305-926-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9250133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic