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General NPI Number Information
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NPI Number | 1235796517
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Entity Type | Individual
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Provider Name | KIMBERLY MAINES RD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 4500 8TH DIVISION RD
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City | COLUMBIA
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State | SC
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Zip | 29207-5700
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Country | US
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Telephone | 803-830-0220
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Fax |
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Provider Business Mailing Address
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Address Line | 300 S GRAND BLVD APT 1101
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City | SAINT LOUIS
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State | MO
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Zip | 63103-2442
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Country | US
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Telephone |
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Fax |
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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 | 86083628
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License Number State | TX
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