Provider Demographics
NPI:1871861799
Name:BOND, KIMBERLY LYNN (RD, LMNT, LD, CNSC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNN
Last Name:BOND
Suffix:
Gender:F
Credentials:RD, LMNT, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1969 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-4464
Mailing Address - Country:US
Mailing Address - Phone:712-326-5722
Mailing Address - Fax:
Practice Address - Street 1:1969 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-4464
Practice Address - Country:US
Practice Address - Phone:712-326-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01583133V00000X
NE601133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE601OtherMEDICAL NUTRITION THERAPIST
IA898982OtherREGISTERED DIETITIAN
IA01583OtherLICENSED DIETITIAN