MEDICARE: KIMBERLY J LEDDEN MNT

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	132700000X	Dietary Manager	37000507A	IN

General Provider Information

NPI Number	:	1871588814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY J LEDDEN MNT

Provider Business Mailing Address
First Line	:	2900 16TH ST
Second Line	:
City	:	BEDFORD
State	:	IN
Zip	:	47421-3510
Country	:	US
Telephone Number	:	812-275-1200
Fax Number	:	812-275-1370

Provider Business Practice Location Address
First Line	:	2900 16TH ST
Second Line	:
City	:	BEDFORD
State	:	IN
Zip	:	47421-3510
Country	:	US
Telephone Number	:	812-275-1200
Fax Number	:	812-275-1370

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	05/18/2009

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