Active NPI
Kimberly McDonough, RD
- Registered Dietitian
- Glendale, AZ
National Provider Identifier
1366853434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1054529
- Practice address
- 17505 N 79TH Ave
Suite 407
Glendale, AZ 85308-8725 - Phone
- (623) 399-6825
- Fax
- (623) 505-3474
- NPI assigned
- May 12, 2014
- Last updated
- May 12, 2014
- Sex
- Female
- Sole proprietor
- No
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 | 1054529 | IL | Primary |
Addresses
Primary practice location
17505 N 79TH Ave
Suite 407
Glendale, AZ 85308-8725
Mailing address
17505 N 79TH Ave
Suite 210
Glendale, AZ 85308-8725
Phone (623) 399-6825
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1054529 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399852800000",
"number": "1366853434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17505 N 79TH AVE",
"address_2": "SUITE 210",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853088725",
"telephone_number": "623-399-6825",
"fax_number": "623-505-3474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17505 N 79TH AVE",
"address_2": "SUITE 407",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853088725",
"telephone_number": "623-399-6825",
"fax_number": "623-505-3474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONOUGH",
"first_name": "KIMBERLY",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-12",
"last_updated": "2014-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "1054529",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.