Provider Demographics
NPI:1831631340
Name:MCDEVITT, KIMBERLY CLEAVES DEVINE (MPH RD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CLEAVES DEVINE
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:MPH RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E DARRAH LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3716
Mailing Address - Country:US
Mailing Address - Phone:443-310-4456
Mailing Address - Fax:
Practice Address - Street 1:12 E DARRAH LN
Practice Address - Street 2:
Practice Address - City:LAWRENCE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08648-3716
Practice Address - Country:US
Practice Address - Phone:443-310-4456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86007483133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ86007483OtherACADEMY OF NUTRITION AND DIETETICS