Provider Demographics
NPI:1235935859
Name:GIBBS, KIMBERLEA N (MPH, RDN, LD)
Entity type:Individual
Prefix:
First Name:KIMBERLEA
Middle Name:N
Last Name:GIBBS
Suffix:
Gender:
Credentials:MPH, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 MARYLAND DR. ST. A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294
Mailing Address - Country:US
Mailing Address - Phone:202-758-8652
Mailing Address - Fax:
Practice Address - Street 1:1117 E POINTE DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1171
Practice Address - Country:US
Practice Address - Phone:202-758-8652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4878133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered