Healthcare Provider Details

I. General information

NPI: 1831631340
Provider Name (Legal Business Name): KIMBERLY CLEAVES DEVINE MCDEVITT MPH R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E DARRAH LN
LAWRENCE TOWNSHIP NJ
08648-3716
US

IV. Provider business mailing address

12 E DARRAH LN
LAWRENCE TOWNSHIP NJ
08648-3716
US

V. Phone/Fax

Practice location:
  • Phone: 443-310-4456
  • Fax:
Mailing address:
  • Phone: 443-310-4456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86007483
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number86007483
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: