Provider Demographics
NPI:1447524962
Name:WROBLE, KYMBERLY ANN (RD, LD)
Entity type:Individual
Prefix:MISS
First Name:KYMBERLY
Middle Name:ANN
Last Name:WROBLE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 PENN CT
Mailing Address - Street 2:UNIT 11
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9668
Mailing Address - Country:US
Mailing Address - Phone:309-781-8259
Mailing Address - Fax:319-354-5410
Practice Address - Street 1:1720 WATERFRONT DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4414
Practice Address - Country:US
Practice Address - Phone:319-354-7601
Practice Address - Fax:319-354-5410
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001865133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered