Kimberly Kay Koevenig, RD, LD/N, CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

ND 637 Issued in FL

Practice address

311 N Clyde Morris Blvd
Suite 440-Outpatient Diabetes Education, Halifax Health
Daytona Beach, FL 32114-2781

Phone

(386) 258-4829

Fax

(386) 255-3109

NPI assigned

Feb 16, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297814400000",
    "number": "1063719672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1189 SOUTHFORK CT",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321292494",
            "telephone_number": "386-506-7841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 N CLYDE MORRIS BLVD",
            "address_2": "SUITE 440-OUTPATIENT DIABETES EDUCATION, HALIFAX HEALTH",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142781",
            "telephone_number": "386-258-4829",
            "fax_number": "386-255-3109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEVENIG",
        "first_name": "KIMBERLY",
        "middle_name": "KAY",
        "name_prefix": "Ms.",
        "credential": "RD, LD/N, CDE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-16",
        "last_updated": "2011-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND 637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wayne Alan Knocke, RPH
• Jennifer Koblik
• Matthew J Kocisko, MD
• Lucas Todd Kockler, LMHC
• Joyson Kodiyan, MD
• Michael D Kohen, M.D.
• Frank R Kohler Jr., D.O.
• Sutinder Singh Kohli, BDS,MS,FAGD
• Bassem Koleilat, MD
• Madhavi Kondur Muppala, M.D.

• Registered Dietitian in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.