Provider Demographics
NPI:1306091129
Name:THOMSEN, KIM N (RD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:N
Last Name:THOMSEN
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 1:3851 ROGER BROOKE DRIVE, BAMC
Mailing Address - Street 2:NUTRITION CARE DIV (ATTN: MCHF-DF)
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:210-916-5525
Mailing Address - Fax:210-916-1991
Practice Address - Street 1:3851 ROGER BROOKE DRIVE, BAMC
Practice Address - Street 2:NUTRITION CARE DIV (ATTN: MCHF-DF)
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-916-5525
Practice Address - Fax:210-916-1991
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05731133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered