Provider Demographics
NPI:1063293447
Name:RICHARDSON, KIMBERLEE (RN-DIABETES EDUCATOR)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RN-DIABETES EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2905
Mailing Address - Country:US
Mailing Address - Phone:573-458-8899
Mailing Address - Fax:573-341-5611
Practice Address - Street 1:1000 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2905
Practice Address - Country:US
Practice Address - Phone:573-458-8899
Practice Address - Fax:573-341-5611
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020005239163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator