Provider Demographics
NPI:1275339517
Name:NIBERT, KARYN (RD/LDN)
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:NIBERT
Suffix:
Gender:
Credentials:RD/LDN
Other - Prefix:
Other - First Name:KARYN
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 GROVE PARK LN
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-6039
Mailing Address - Country:US
Mailing Address - Phone:321-223-5784
Mailing Address - Fax:
Practice Address - Street 1:530 GROVE PARK LN
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-6039
Practice Address - Country:US
Practice Address - Phone:321-223-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3136133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered