Provider Demographics
NPI:1699943746
Name:CAMPBELL, KIMBERLY ILEEN (RD LDN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ILEEN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 NORLAND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4230
Mailing Address - Country:US
Mailing Address - Phone:717-217-6820
Mailing Address - Fax:
Practice Address - Street 1:757 NORLAND AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4230
Practice Address - Country:US
Practice Address - Phone:717-217-6820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000622133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered