Individual
KIMBERLY J. KENGOR
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MS, RD, CDE
Contact information
Practice address
900 SAHARA TRL, YOUNGSTOWN, OH 44514-3667
(330) 506-2336
(330) 270-5773
Mailing address
PO BOX 11230, YOUNGSTOWN, OH 44511-0230
(330) 506-2336
(330) 270-5733
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
419
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000003266560
ANTHEM DIABETES EDUCATOR
OH
01
—
721593
AETNA, DIETITIAN
OH
Enumeration date
12/08/2005
Last updated
07/08/2007
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