Healthcare Provider Details

I. General information

NPI: 1578999058
Provider Name (Legal Business Name): KYMBERLI LEN SOWELL RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 06/07/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD # D-436
MOBILE AL
36608-6705
US

IV. Provider business mailing address

6701 AIRPORT BLVD # D-436
MOBILE AL
36608-6705
US

V. Phone/Fax

Practice location:
  • Phone: 251-266-1987
  • Fax: 251-266-2070
Mailing address:
  • Phone: 251-266-1987
  • Fax: 251-266-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1951
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: