Individual provider Active NPI

Kimberly A Evans, MS RD

  • Registered Dietitian
  • Needham, MA
National Provider Identifier
1619164118
Registry record updated Mar 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Practice address
117 Kendrick St Ste 300
Needham, MA 02494-2722
Phone
(802) 391-9076
Fax
(802) 503-0556
NPI assigned
Sep 28, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X Primary

Addresses

Primary practice location

117 Kendrick St Ste 300
Needham, MA 02494-2722

Mailing address

220 Narragansett Ave
Riverside, RI 02915-5608
Phone (802) 391-9076

Other practice location 1

134 Thurbers Ave Ste 205
Providence, RI 02905-4754
Phone (802) 391-9076

Other practice location 2

68 Folsham Hollow Rd
South Burlington, VT 05403-5613
Phone (802) 391-9076

Other identifiers 1

IdentifierTypeStateIssuer
1017597MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091024000054 VT Practitioner - Registered Dietitian Or Nutrition Professional 9234276270 Practice locations: South Burlington, VT

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Vermont Center for Integrative Therapy, LLC PastSince Sep 28, 2011 Accepting new patients
Fay Nutrition Dietitian, Registered Past Accepting new patients
Kimberly Evans Rd Dietitian, Registered Past Accepting new patients
Elite Health and Wellness LLC Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710979200000",
    "number": "1619164118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 NARRAGANSETT AVE",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029155608",
            "telephone_number": "802-391-9076",
            "fax_number": "802-503-0556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 KENDRICK ST STE 300",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024942722",
            "telephone_number": "802-391-9076",
            "fax_number": "802-503-0556"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "134 Thurbers Ave Ste 205",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029054754",
            "country_code": "US",
            "telephone_number": "802-391-9076",
            "fax_number": "802-503-0556",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "68 Folsham Hollow Rd",
            "address_purpose": "LOCATION",
            "city": "South Burlington",
            "state": "VT",
            "postal_code": "054035613",
            "country_code": "US",
            "telephone_number": "802-391-9076",
            "fax_number": "802-503-0556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVANS",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "MS RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-28",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017597",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Needham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.