Active NPI
Kimberly A Rondeau, RD,LD
- Registered Dietitian
- Tualatin, OR
National Provider Identifier
1659522498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 436
- Practice address
- 19185 SW 90TH Ave
Tualatin, OR 97062-7558 - Phone
- (503) 885-5385
- Fax
- (503) 885-7388
- NPI assigned
- Oct 9, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | 436 | OR | Primary |
Addresses
Primary practice location
19185 SW 90TH Ave
Tualatin, OR 97062-7558
Mailing address
1256 SE 16TH Ave
Canby, OR 97013-6308
Phone (503) 263-1628
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 |
|---|---|---|---|
| 436 | OR | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223510400000",
"number": "1659522498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1256 SE 16TH AVE",
"city": "CANBY",
"state": "OR",
"postal_code": "970136308",
"telephone_number": "503-263-1628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19185 SW 90TH AVE",
"city": "TUALATIN",
"state": "OR",
"postal_code": "970627558",
"telephone_number": "503-885-5385",
"fax_number": "503-885-7388"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RONDEAU",
"first_name": "KIMBERLY",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "RD,LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-09",
"last_updated": "2008-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OR",
"license": "436",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tualatin, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.