Provider Demographics
NPI:1386489136
Name:ECKERT, KIMBERLY (RD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ECKERT
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 1:1908 RESTON METRO PLZ APT 324
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5947
Mailing Address - Country:US
Mailing Address - Phone:703-965-5585
Mailing Address - Fax:
Practice Address - Street 1:44075 PIPELINE PLZ STE 300
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5889
Practice Address - Country:US
Practice Address - Phone:703-651-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered