Provider Demographics
NPI:1528451226
Name:YOUNG, KIMBERLY (CERTIFIED CNE)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CERTIFIED CNE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5919
Mailing Address - Country:US
Mailing Address - Phone:202-369-1792
Mailing Address - Fax:
Practice Address - Street 1:8900 COLUMBIA 100 PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2336
Practice Address - Country:US
Practice Address - Phone:202-369-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist