Healthcare Provider Details

I. General information

NPI: 1497126155
Provider Name (Legal Business Name): KIMBERLY JEROME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW SUITE 3400 NORTH
WASHINGTON DC
20010-2927
US

IV. Provider business mailing address

106 IRVING ST NW SUITE 3400 NORTH
WASHINGTON DC
20010-2927
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI100000755
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: