MRS. KIMBERLY M OTTER


Address: 935 Jersey St, Quincy, IL 62301-4030
Phone: 2172282413

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

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

Office Location

Street Address 935 JERSEY ST
City QUINCY
State IL
Zip Code 62301-4030

Providers in the same location

NPI Name Taxonomy Address Enumeration
1851305304 Mindy Lee Wallace Dietitian, Registered 935 Jersey St, Quincy, IL 62301-4030 2006-07-28

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1043851488 West Central Illinois Nutrition In Home Supportive Care 639 York St. Room 333, Quincy, IL 62301 2019-10-07
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1194255083 Michael Andrew Behrens Nurse Practitioner Broadway and 11th Street, Quincy, IL 62301 2017-06-14
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Taxonomy Information

Taxonomy Code 133V00000X
Grouping Dietary & Nutritional Service Providers
Classification Dietitian, Registered

Taxonomy Definition

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.

Providers in the same taxonomy and city

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
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Competitor

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City QUINCY
Zip Code 62301

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Dataset Information

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.

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