Provider Demographics
NPI:1891568366
Name:DRYER, KIMBERLY JANE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JANE
Last Name:DRYER
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JANE
Other - Last Name:DRYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:837 RIO GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6384
Mailing Address - Country:US
Mailing Address - Phone:812-577-6249
Mailing Address - Fax:
Practice Address - Street 1:2201 SE LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-5863
Practice Address - Country:US
Practice Address - Phone:800-443-9672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87830133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered