Provider Demographics
NPI:1366983298
Name:YOUNG, KIMBERLY (MS, CNS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 COLE AVE
Mailing Address - Street 2:#600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5412
Mailing Address - Country:US
Mailing Address - Phone:214-923-5450
Mailing Address - Fax:214-559-7103
Practice Address - Street 1:4514 COLE AVE
Practice Address - Street 2:#600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5412
Practice Address - Country:US
Practice Address - Phone:214-923-5450
Practice Address - Fax:214-559-7103
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-11
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist