Active NPI
Amy Kimberly
- Registered Dietitian
- Myrtle Beach, SC
National Provider Identifier
1033748033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 6169 Chadderton Cir
Myrtle Beach, SC 29579-4483 - Phone
- (304) 550-1994
- NPI assigned
- Apr 2, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
6169 Chadderton Cir
Myrtle Beach, SC 29579-4483
Mailing address
6169 Chadderton Cir
Myrtle Beach, SC 29579-4483
Phone (304) 550-1994
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | RD | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585785600000",
"number": "1033748033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6169 CHADDERTON CIR",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295794483",
"telephone_number": "304-550-1994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6169 CHADDERTON CIR",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295794483",
"telephone_number": "304-550-1994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBERLY",
"first_name": "AMY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-02",
"last_updated": "2020-04-02",
"certification_date": "2020-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "RD",
"affiliation": "N",
"endpointDescription": "Nutrition/Dietitian",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "6169 Chadderton Cir",
"city": "Myrtle Beach",
"state": "SC",
"country_code": "US",
"postal_code": "295794483",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.