Provider Demographics
NPI:1922625581
Name:STEPHENSON, KYMBER JANELLE (RDN)
Entity Type:Individual
Prefix:
First Name:KYMBER
Middle Name:JANELLE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 S VERBENA ST APT 318
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1538
Mailing Address - Country:US
Mailing Address - Phone:678-522-5036
Mailing Address - Fax:
Practice Address - Street 1:8120 SHERIDAN BLVD.
Practice Address - Street 2:BUILDING C, SUITE C-315
Practice Address - City:WESTMINISTER
Practice Address - State:CO
Practice Address - Zip Code:80003
Practice Address - Country:US
Practice Address - Phone:708-717-7394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86173235133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered