Provider Demographics
NPI:1366200339
Name:YAWITZ, KIMBERLY (RD)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:YAWITZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1026
Mailing Address - Country:US
Mailing Address - Phone:314-323-3603
Mailing Address - Fax:
Practice Address - Street 1:6 BERKSHIRE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1026
Practice Address - Country:US
Practice Address - Phone:314-323-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016038550133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered