1356563142 NPI number — MS. KIMBERLY CAUDILL MS, RD, CNSC

Table of content: MS. KIMBERLY CAUDILL MS, RD, CNSC (NPI 1356563142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356563142 NPI number — MS. KIMBERLY CAUDILL MS, RD, CNSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAUDILL
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, CNSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356563142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9100 SEAVEY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOOMIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95650-8898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-830-2551
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
970 RESERVE DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95678-1377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-830-2551
Provider Business Practice Location Address Fax Number:
997-000-7116
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 81-4254412 . This is a "REGISTERED DIETITIAN" identifier . This identifiers is of the category "OTHER".




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