Provider Demographics
NPI:1538432398
Name:LARUE, KIMBERLY K (RD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:LARUE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:KREMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1230 N 30TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0128
Mailing Address - Country:US
Mailing Address - Phone:406-237-4280
Mailing Address - Fax:406-237-4285
Practice Address - Street 1:1230 N 30TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0128
Practice Address - Country:US
Practice Address - Phone:406-237-4280
Practice Address - Fax:406-237-4285
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT248133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT248OtherMONTANA LICENSE