Basic Information
| Provider Information | |||||||||
| NPI: | 1851684260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARTHY-NUSSBAUM | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CLINICAL DIETITIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4440 RED BANK EXPRESSWAY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135643914 | ||||||||
| FaxNumber: | 5132720316 | ||||||||
| Practice Location | |||||||||
| Address1: | 4440 REDBANK EXPRESSWAY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132720313 | ||||||||
| FaxNumber: | 5132720316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2011 | ||||||||
| LastUpdateDate: | 03/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | LD1010 | OH | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.