1538563168 NPI number — MRS. KIMBERLY ANN LEE MS, RDN, LDN

Table of content: MRS. KIMBERLY ANN LEE MS, RDN, LDN (NPI 1538563168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538563168 NPI number — MRS. KIMBERLY ANN LEE MS, RDN, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
KIMBERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RDN, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHANDRA
Provider Other First Name:
KIM
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538563168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 SUNDAY DR STE 309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27607-5254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-354-7077
Provider Business Mailing Address Fax Number:
919-354-7075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 SUNDAY DR STE 309
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-5254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-354-7077
Provider Business Practice Location Address Fax Number:
919-354-7075
Provider Enumeration Date:
10/10/2014

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 , with the licence number:  L003883 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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