Provider Demographics
NPI:1851684260
Name:MCCARTHY-NUSSBAUM, KIM (CLINICAL DIETITIAN)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:MCCARTHY-NUSSBAUM
Suffix:
Gender:F
Credentials:CLINICAL DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 RED BANK EXPRESSWAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-564-3914
Mailing Address - Fax:513-272-0316
Practice Address - Street 1:4440 REDBANK EXPRESSWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-272-0313
Practice Address - Fax:513-272-0316
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD1010133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered