Healthcare Provider Details

I. General information

NPI: 1528451226
Provider Name (Legal Business Name): KIMBERLY YOUNG CERTIFIED CNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 COLUMBIA 100 PKWY SUITE G
COLUMBIA MD
21045-2336
US

IV. Provider business mailing address

4240 COLUMBIA RD
ELLICOTT CITY MD
21042-5919
US

V. Phone/Fax

Practice location:
  • Phone: 202-369-1792
  • Fax:
Mailing address:
  • Phone: 202-369-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: