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Individual

MS. KIMBERLY KAY KOEVENIG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RD, LD/N, CDE

Contact information

Practice address
311 N CLYDE MORRIS BLVD, SUITE 440-OUTPATIENT DIABETES EDUCATION, HALIFAX HEALTH, DAYTONA BEACH, FL 32114-2781
(386) 258-4829
(386) 255-3109
Mailing address
1189 SOUTHFORK CT, PORT ORANGE, FL 32129-2494
(386) 506-7841

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND 637
FL

Other

Enumeration date
02/16/2011
Last updated
02/16/2011
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