Healthcare Provider Details

I. General information

NPI: 1659398105
Provider Name (Legal Business Name): KIMBERLY BOYD HEATH R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 SMITH RD
HOKES BLUFF AL
35903-4695
US

IV. Provider business mailing address

430 SMITH RD
HOKES BLUFF AL
35903-4695
US

V. Phone/Fax

Practice location:
  • Phone: 256-492-5295
  • Fax:
Mailing address:
  • Phone: 256-492-5295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number884
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: