Kimberly Koehler, RD
Individual provider Active NPI Registered Dietitian · Arlington, TN
NPI 1083379002 · NPPES record last updated Nov 4, 2021
Key facts
- NPI
- 1083379002
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 3029 (TN)
- Practice address
- 6428 Burren CV
Arlington, TN 38002-2552 - Phone
- (901) 355-4340
- NPI assigned
- Nov 4, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3029 | TN | MD | Obstetrics & Gynecology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 3029 | TN | Yes |
Addresses
Primary practice location
6428 Burren CV
Arlington, TN 38002-2552
Mailing address
6428 Burren CV
Arlington, TN 38002-2552
Phone (901) 355-4340
NPI Registry JSON
{
"created_epoch": "1635984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635984000000",
"number": "1083379002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6428 BURREN CV",
"city": "ARLINGTON",
"state": "TN",
"postal_code": "380022552",
"telephone_number": "901-355-4340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6428 BURREN CV",
"city": "ARLINGTON",
"state": "TN",
"postal_code": "380022552",
"telephone_number": "901-355-4340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOEHLER",
"first_name": "KIMBERLY",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-04",
"last_updated": "2021-11-04",
"certification_date": "2021-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TN",
"license": "3029",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.