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General NPI Number Information
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NPI Number | 1194177808
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Entity Type | Individual
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Provider Name | JANET KIMMONS R.D.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2016
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 1600 E BROADWAY
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City | COLUMBIA
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State | MO
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Zip | 65201-5844
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Country | US
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Telephone | 573-815-3258
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Fax | 573-815-6414
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Provider Business Mailing Address
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Address Line | 1600 E BROADWAY
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City | COLUMBIA
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State | MO
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Zip | 65201-5844
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Country | US
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Telephone | 573-815-3258
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Fax | 573-815-6414
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 132700000X
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Taxonomy Name | Dietary Manager
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License Number | 2002025461
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License Number State | MO
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