Provider Demographics
NPI:1760586291
Name:STEPHENSON, KIMBERLY E (RD, LDN,CSP, CN,MS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:E
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:RD, LDN,CSP, CN,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 FRIDAY CENTER DR
Mailing Address - Street 2:SUITE 2091, ROOM 2102
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-9499
Mailing Address - Country:US
Mailing Address - Phone:919-966-0420
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-966-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001737133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
2994365Medicare ID - Type UnspecifiedPERFORMING PROV NUMBER