Kimberly Nicole Nicholas, RD, LD
Individual provider Active NPI Registered Dietitian · Lexington, LA
NPI 1861656019 · NPPES record last updated Jul 17, 2008
Key facts
- NPI
- 1861656019
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- KY-1189 (KY)
- Practice address
- 805 Newtown Pike
Lexington, LA 40511 - Phone
- (859) 288-2346
- NPI assigned
- Jul 17, 2008
- 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 |
|---|---|---|---|
| KY-1189 | KY | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | KY-1189 | KY | Yes |
Addresses
Primary practice location
805 Newtown Pike
Lexington, LA 40511
Mailing address
650 Newtown Pike
Lexington, KY 40508-1113
Phone (859) 288-2346
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2008. 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.