Provider Demographics
NPI:1932403557
Name:WALDON, KIMBERLY KRYSTLE (MS, RD, CD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KRYSTLE
Last Name:WALDON
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:KRYSTLE
Other - Last Name:REAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CD
Mailing Address - Street 1:2500 OVERLOOK TER
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 OVERLOOK TER
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2254
Practice Address - Country:US
Practice Address - Phone:608-256-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered