Individual
KIMBERLY M ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, MPH, RD, LD/N
Contact information
Practice address
10257 SW VILLAGE PKWY APT 202, PORT SAINT LUCIE, FL 34987-2367
(863) 697-0804
Mailing address
10257 SW VILLAGE PWKY APT 202, PORT SAINT LUCIE, FL 34987
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND6277
FL
Other
Enumeration date
06/03/2024
Last updated
06/09/2024
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