Provider Demographics
NPI:1982337465
Name:CREECH, KIMBERLEE (RD)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:CREECH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:
Other - Last Name:GOODEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14611 N 4800 W
Mailing Address - Street 2:
Mailing Address - City:CORNISH
Mailing Address - State:UT
Mailing Address - Zip Code:84308-3007
Mailing Address - Country:US
Mailing Address - Phone:435-770-7341
Mailing Address - Fax:
Practice Address - Street 1:2380 N 400 E
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-6000
Practice Address - Country:US
Practice Address - Phone:435-713-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86079769133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered