Provider Demographics
NPI:1295967834
Name:JONES, KIMBERLY PATRICE (RDN)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:PATRICE
Last Name:JONES
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 1:18641 MAGARETA STREET
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2930
Mailing Address - Country:US
Mailing Address - Phone:248-228-6112
Mailing Address - Fax:
Practice Address - Street 1:18641 MARGARETA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2930
Practice Address - Country:US
Practice Address - Phone:248-228-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-16
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL931092133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered