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General NPI Number Information
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NPI Number | 1881116853
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Entity Type | Individual
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Provider Name | KIMBERLY ROSS DCN, CNS, CDN, LDN
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 1201 6TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-7400
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Country | US
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Telephone | 941-234-4541
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Fax | 941-213-5822
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Provider Business Mailing Address
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Address Line | 7026 DATE PALM LN
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City | ELLENTON
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State | FL
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Zip | 34222-4316
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Country | US
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Telephone | 941-234-4541
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Fax | 941-213-5822
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | LD.10482
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DX6749
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | ND9114
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 164.008863
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 008524
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND9114
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License Number State | FL
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