Provider Demographics
NPI:1538721121
Name:KIM RILEY NUTRITION LLC
Entity type:Organization
Organization Name:KIM RILEY NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDE, LDN
Authorized Official - Phone:941-800-5565
Mailing Address - Street 1:6146 100TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-4557
Mailing Address - Country:US
Mailing Address - Phone:551-265-8405
Mailing Address - Fax:
Practice Address - Street 1:312 E VENICE AVE STE 208
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4621
Practice Address - Country:US
Practice Address - Phone:941-800-5565
Practice Address - Fax:941-275-6340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty