Individual
KELLI A WIMBERLY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
524 S RYAN ST, LAKE CHARLES, LA 70601-5725
(337) 430-5448
Mailing address
1701 21ST ST, LAKE CHARLES, LA 70601-8941
(337) 479-6056
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1717
LA
Other
Enumeration date
04/07/2006
Last updated
07/08/2007
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