Healthcare Provider Details

I. General information

NPI: 1851684260
Provider Name (Legal Business Name): KIM MCCARTHY-NUSSBAUM CLINICAL DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 REDBANK EXPRESSWAY SUITE 210
CINCINNATI OH
45219
US

IV. Provider business mailing address

4440 RED BANK EXPRESSWAY SUITE 210
CINCINNATI OH
45219
US

V. Phone/Fax

Practice location:
  • Phone: 513-272-0313
  • Fax: 513-272-0316
Mailing address:
  • Phone: 513-564-3914
  • Fax: 513-272-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD1010
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: