Provider Demographics
NPI:1881116853
Name:ROSS, KIMBERLY (DCN, CNS, CDN, LDN)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:DCN, CNS, CDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7026 DATE PALM LN
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-4316
Mailing Address - Country:US
Mailing Address - Phone:941-234-4541
Mailing Address - Fax:941-213-5822
Practice Address - Street 1:1201 6TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-7400
Practice Address - Country:US
Practice Address - Phone:941-234-4541
Practice Address - Fax:941-213-5822
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.10482133N00000X
MDDX6749133N00000X
FLND9114133N00000X, 133V00000X
IL164.008863133N00000X
NY008524133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist