Provider Demographics
NPI:1891794400
Name:DOHM, KIMBERLY B (RD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:B
Last Name:DOHM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:GRAINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67737-0132
Mailing Address - Country:US
Mailing Address - Phone:502-762-6675
Mailing Address - Fax:
Practice Address - Street 1:359 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:GRAINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67737-3739
Practice Address - Country:US
Practice Address - Phone:502-762-6675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002456133V00000X
KS1848133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2993935Medicare ID - Type Unspecified
Q28677Medicare UPIN