Provider Demographics
NPI:1861656019
Name:NICHOLAS, KIMBERLY NICOLE (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NEWTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1113
Mailing Address - Country:US
Mailing Address - Phone:859-288-2346
Mailing Address - Fax:
Practice Address - Street 1:805 NEWTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:LA
Practice Address - Zip Code:40511
Practice Address - Country:US
Practice Address - Phone:859-288-2346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1189133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered