| Provider / Organization | NPI | Date Certified |
|---|---|---|
| KIMBERLY M ELLIS | 1215778444 | 2024-06-09 |
Kimberly M Ellis is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1215778444. Registration indicates Kimberly M Ellis is a provider of services with a specialization in Dietary & Nutritional Service Providers, Dietitian, Registered (Dietitian, Registered, ) (All Other Specialties & Provider Types, ) (Dietitian, Registered, Dietary & Nutritional Service Providers)
| Entity Type | Individual |
| Provider Name | Kimberly M Ellis MS, MPH, RD, LD/N |
| Practice Office Address | 10257 SW VILLAGE PKWY APT 202 PORT SAINT LUCI, FL US |
| Practice Office Telephone | 8636970804 |
| Mailing Address | 10257 SW VILLAGE PWKY APT 202 PORT SAINT LUCIE, FL 34987 US |
| Code | Practice | License No State |
|---|---|---|
| 133V00000X PRIMARY | Dietary & Nutritional Service Providers Dietitian, Registered Dietitian, Registered All Other Specialties & Provider Types Dietitian, Registered Dietary & Nutritional Service Providers | ND6277
FL |