=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538013206
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY SUE MORISSETTE MS, RDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2026
-----------------------------------------------------
Last Update Date | 02/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12629 468TH AVE SE
-----------------------------------------------------
City | NORTH BEND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98045-8801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-430-1722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12629 468TH AVE SE
-----------------------------------------------------
City | NORTH BEND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98045-8801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 811655
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------