Provider Demographics
NPI:1063911188
Name:GRIFFIN, KIMBERLY S (RD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 CANTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-8431
Mailing Address - Country:US
Mailing Address - Phone:269-998-9375
Mailing Address - Fax:
Practice Address - Street 1:6319 CANTERWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-8431
Practice Address - Country:US
Practice Address - Phone:269-998-9375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-04
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered