Provider Demographics
NPI:1457567182
Name:SCARPA, KIMBERLY ANN (BSRD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:SCARPA
Suffix:
Gender:F
Credentials:BSRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1709
Mailing Address - Country:US
Mailing Address - Phone:856-678-7373
Mailing Address - Fax:856-678-7373
Practice Address - Street 1:65 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1709
Practice Address - Country:US
Practice Address - Phone:856-678-7373
Practice Address - Fax:856-678-7373
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered