Healthcare Provider Details

I. General information

NPI: 1063326106
Provider Name (Legal Business Name): KIMBERLEE BEISTLINE RD, LDN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLEE JONATZKE

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 HUDDLESTON DR
CACHE OK
73527-9603
US

IV. Provider business mailing address

825 HUDDLESTON DR
CACHE OK
73527-9603
US

V. Phone/Fax

Practice location:
  • Phone: 727-534-3839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND9242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: