Provider Demographics
NPI:1215492871
Name:HIGGINS, KIMBERLY VIRKLER (RD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:VIRKLER
Last Name:HIGGINS
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 1:2801 SOMMERSBY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-8049
Mailing Address - Country:US
Mailing Address - Phone:410-530-3180
Mailing Address - Fax:
Practice Address - Street 1:2801 SOMMERSBY RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-8049
Practice Address - Country:US
Practice Address - Phone:410-530-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty