Provider Demographics
NPI:1942525696
Name:TIMMS, COLLEEN A (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:A
Last Name:TIMMS
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 1:2655 W NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-3617
Mailing Address - Country:US
Mailing Address - Phone:937-525-3067
Mailing Address - Fax:937-505-4007
Practice Address - Street 1:2655 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-3617
Practice Address - Country:US
Practice Address - Phone:937-525-3067
Practice Address - Fax:937-505-4007
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL2150133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered