Provider Demographics
NPI:1669112181
Name:MARSH, KIMBERLY (RDN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MARSH
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 1:21558 OMAHA AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7238
Mailing Address - Country:US
Mailing Address - Phone:801-556-8691
Mailing Address - Fax:
Practice Address - Street 1:21558 OMAHA AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7238
Practice Address - Country:US
Practice Address - Phone:801-556-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1011069133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered