Basic Information
| Provider Information | |||||||||
| NPI: | 1104279181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDIN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | CERTIFIED DIETICIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1503 N MITTHOEFFER RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462292425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173559338 | ||||||||
| FaxNumber: | 3173556150 | ||||||||
| Practice Location | |||||||||
| Address1: | 2040 N SHADELAND AVE | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462191711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173553232 | ||||||||
| FaxNumber: | 3173557851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2016 | ||||||||
| LastUpdateDate: | 07/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 37000308A | IN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.