Provider Demographics
NPI:1245631431
Name:KIMBLE, INC.
Entity type:Organization
Organization Name:KIMBLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:407-397-9705
Mailing Address - Street 1:5263 IMAGES CIR
Mailing Address - Street 2:#106
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-4756
Mailing Address - Country:US
Mailing Address - Phone:407-397-9705
Mailing Address - Fax:
Practice Address - Street 1:5263 IMAGES CIR
Practice Address - Street 2:#106
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4756
Practice Address - Country:US
Practice Address - Phone:407-397-9705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3529133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL348585Medicare PIN