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General NPI Number Information
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NPI Number | 1861510711
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Entity Type | Individual
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Provider Name | NANCY J KEIM RD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1001 NORTH HIGHWAY 25
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City | BLOOMFIELD
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State | MO
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Zip | 63825-0000
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Country | US
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Telephone | 573-238-1620
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Fax | 567-568-4736
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Provider Business Mailing Address
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Address Line | PO BOX 23
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City | LEOPOLD
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State | MO
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Zip | 63760-0023
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Country | US
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Telephone | 573-568-4593
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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 | 2005020910
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License Number State | MO
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