Provider Demographics
NPI:1356563142
Name:CAUDILL, KIMBERLY (MS, RD, CNSC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:MS, RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 SEAVEY LN
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-8898
Mailing Address - Country:US
Mailing Address - Phone:530-830-2551
Mailing Address - Fax:
Practice Address - Street 1:970 RESERVE DR STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1377
Practice Address - Country:US
Practice Address - Phone:530-830-2551
Practice Address - Fax:997-000-7116
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
81-4254412OtherREGISTERED DIETITIAN