Provider Demographics
NPI:1053750638
Name:TALBOT, KIMBERLY (RD LDN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:TALBOT
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2515
Mailing Address - Country:US
Mailing Address - Phone:617-291-0764
Mailing Address - Fax:
Practice Address - Street 1:14 TSIENNETO RD
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1647
Practice Address - Country:US
Practice Address - Phone:617-291-0764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2032133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered