Provider Demographics
NPI:1396979423
Name:PRATT, KIMBERLY MADDOCK (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MADDOCK
Last Name:PRATT
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COLCHESTER AVENUE
Mailing Address - Street 2:FLETCHER ALLEN HEALTHCARE
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-4760
Mailing Address - Fax:
Practice Address - Street 1:100 COLCHESTER AVENUE
Practice Address - Street 2:FLETCHER ALLEN HEALTHCARE
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0000196133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered