MEDICARE: LINDSEY GRACE JULLIETTE KIMBROUGH RD/RDN, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist	86298219	TX
2	133V00000X	Registered Dietitian	86298219	TX

General Provider Information

NPI Number	:	1780533570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY GRACE JULLIETTE KIMBROUGH RD/RDN, LD

Provider Business Mailing Address
First Line	:	PO BOX 9398
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96158-2398
Country	:	US
Telephone Number	:	530-318-8587
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 SLADECEK DR UNIT A
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-6648
Country	:	US
Telephone Number	:	530-318-8587
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2026
Last Update Date	:	01/24/2026

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