Kimberley Mae Wilson, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86100729 Issued in VA

Practice address

1933 Haviland Dr
Virginia Beach, VA 23454-6704

Phone

(302) 465-3066

NPI assigned

Feb 1, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

University of Alabama School of Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sentara Medical Group

  • Family Medicine Physician
  • Norfolk, VA
  • NPI 1265485270
  Medicare reassignment Care Compare group NPD
• Fay Nutrition

  • Registered Dietitian
  • San Francisco, CA
  • NPI 1104334465

  Dietitian, Registered

  NPD (past)
• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1643673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1104579069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1933 HAVILAND DR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234546704",
            "telephone_number": "302-465-3066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1933 HAVILAND DR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234546704",
            "telephone_number": "302-465-3066"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6333 Center Dr Bldg 16",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235024126",
            "country_code": "US",
            "telephone_number": "757-252-9500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIMBERLEY",
        "middle_name": "MAE",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-01",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "VA",
            "license": "86100729",
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "VA",
            "license": "86100729",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "VA",
            "license": "86100729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James A Wilson, MD
• Jared Michael Wilson, M.D.
• Joel Antwain Wilson Jr.
• Julia Mooney Wilson
• Kenzie Wilson
• Kimberly Evonne Wilson, PTA
• Kristen A Wilson, PHARMD
• Manuel Wilson, DNP, CRNFA, CNOR
• Marcy Wilson, M.S., CCC-SLP
• Michael George Wilson, PHARMD

• Registered Dietitian in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Registered Dietitian in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.