Provider Demographics
NPI:1982337820
Name:MCAULEY, KIMBERLY (RD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MCAULEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3504 CLINTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2145
Mailing Address - Country:US
Mailing Address - Phone:515-695-3316
Mailing Address - Fax:183-371-9124
Practice Address - Street 1:3504 CLINTON PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2145
Practice Address - Country:US
Practice Address - Phone:515-695-3316
Practice Address - Fax:833-719-1241
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10698133V00000X
133V00000X
KS2875133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered