Provider Demographics
NPI:1538563168
Name:LEE, KIMBERLY ANN (MS, RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:ANN
Other - Last Name:CHANDRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:1520 SUNDAY DR STE 309
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5254
Mailing Address - Country:US
Mailing Address - Phone:919-354-7077
Mailing Address - Fax:919-354-7075
Practice Address - Street 1:1520 SUNDAY DR STE 309
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5254
Practice Address - Country:US
Practice Address - Phone:919-354-7077
Practice Address - Fax:919-354-7075
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003883133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered