Provider Demographics
NPI:1285873760
Name:CARR - FREMONT, KIM C (MS/RD/LD)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:C
Last Name:CARR - FREMONT
Suffix:
Gender:F
Credentials:MS/RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8446 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1055
Mailing Address - Country:US
Mailing Address - Phone:800-544-3059
Mailing Address - Fax:314-423-9825
Practice Address - Street 1:8446 PAGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-1055
Practice Address - Country:US
Practice Address - Phone:800-544-3059
Practice Address - Fax:314-423-9825
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.002637133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered