Provider Demographics
NPI:1821227034
Name:MYERS, KIMBERLY J (CN)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:J
Last Name:MYERS
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 WINDSOR DR.
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041
Mailing Address - Country:US
Mailing Address - Phone:606-845-6511
Mailing Address - Fax:606-845-0879
Practice Address - Street 1:194 WINDSOR DR.
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041
Practice Address - Country:US
Practice Address - Phone:606-845-6511
Practice Address - Fax:606-845-0879
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY2113133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education