MRS. KIMBERLY M OTTER (NPI# 1245232909) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1245232909 |
Entity Type | Individual |
Full Name | MRS. KIMBERLY M OTTER |
Other Name | MISS KIMBERLY M SWEDELL I |
Credential | RD LDN |
Practice Address |
935 Jersey St Quincy IL 62301-4030 |
Practice Telephone | 2172282413 |
Practice Fax Number | 2172282416 |
Mailing Telephone | 2172282413 |
Mailing Fax Number | 2172282416 |
Enumeration Date | 2005-08-12 |
Last Update Date | 2007-07-08 |
Gender Code | F |
Is Sole Proprietor | X |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 133V00000X | Dietitian, Registered | 2004029302 | MO | Dietary & Nutritional Service Providers |
Y | 133V00000X | Dietitian, Registered | IL | Dietary & Nutritional Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | PRIVATE HEALTHCARE SYSTEM | 000009329891 | 01 |
IL | QUINCY HEALTH CARE MGMT. | 075113 | 01 |
IL | BLUE CROSS BLUE SHIELD | 00132009 | 01 |
Street Address |
935 JERSEY ST |
City | QUINCY |
State | IL |
Zip Code | 62301-4030 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1851305304 | Mindy Lee Wallace | Dietitian, Registered | 935 Jersey St, Quincy, IL 62301-4030 | 2006-07-28 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1356969471 | Lutheran Child and Family Service of Illinois | Foster Care Agency | 1400 N. 30th St, Quincy, IL 62301 | 2020-07-07 |
1134749716 | Bethany Nicole Jumps | Pharmacist | Broadway St & N 11th St, Quincy, IL 62301 | 2020-04-23 |
1043844293 | S.crider Construction An Supply Corp. | Contractor | 529 Woodbridge Dr., Quincy, IL 62301 | 2020-02-26 |
1245862002 | Quincy Physicians & Surgeons Clinic, Sc | Clinic/Center | 3301 Broadway St., Quincy, IL 62301 | 2020-02-10 |
1043851488 | West Central Illinois Nutrition | In Home Supportive Care | 639 York St. Room 333, Quincy, IL 62301 | 2019-10-07 |
1861986549 | Quincy Physicians & Surgeons Clinic, Sc | Internal Medicine | 3347 Broadway St, Quincy, IL 62301 | 2018-06-18 |
1194255083 | Michael Andrew Behrens | Nurse Practitioner | Broadway and 11th Street, Quincy, IL 62301 | 2017-06-14 |
1770987323 | Kirsty Yvonne Reed | Counselor | 205 S. 24th Street, Chaddock, Quincy, IL 62301 | 2014-10-10 |
1114234499 | Dale D. Shahan Dds Ltd | Dentist | 636 Hampshire Suite 102, Quincy, IL 62301 | 2010-09-08 |
1730314071 | James D Kaufmann | Pharmacist | 14th & Broadway, Quincy, IL 62301 | 2009-05-15 |
Find all providers in zip 62301 |
Taxonomy Code | 133V00000X |
Grouping | Dietary & Nutritional Service Providers |
Classification | Dietitian, Registered |
A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1669087946 | Michelle Pearson | Dietitian, Registered | 12 Vine Ave Apt 3, Quincy, MA 02169-5617 | 2020-09-13 |
1912517673 | Rachel Andrade | Dietitian, Registered | 333 Ricciuti Dr Apt 433, Quincy, MA 02169-6291 | 2020-08-06 |
1790232239 | Kellie Conroy | Dietitian, Registered | 14 Alleyne Street, Suite B, Quincy, MA 02169 | 2016-09-01 |
1821485616 | Renee Demartini | Dietitian, Registered | 512 Sea St, Quincy, MA 02169-2702 | 2015-04-20 |
1033463146 | A Healthy Balance, Inc. | Dietitian, Registered | 14b Alleyne Street, Quincy, MA 02169-2009 | 2012-10-29 |
1982872966 | Amy E Holtz | Dietitian, Registered | 40 Richie Rd, Quincy, MA 02169-7827 | 2008-02-13 |
1588845648 | Mary Clare Reiter | Dietitian, Registered | 4505 Homan Creek Dr, Quincy, IL 62305-9633 | 2007-11-16 |
1750595831 | Jessica S Miller | Dietitian, Registered | 2002 Sawdust Rd, Quincy, FL 32351-8839 | 2007-05-09 |
1659459956 | Lori Fran Lieberman | Dietitian, Registered | 111 Willard St Ste 2f, Quincy, MA 02169-1274 | 2006-11-02 |
1851998058 | Whole Lifecycle Nutrition LLC | Dietitian, Registered | 333 Ricciuti Dr Apt 433, Quincy, MA 02169-6291 | 2020-10-01 |
Find all providers in QUINCY |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.