| |
422 Cabernet Drive, Vine Grove, KY 40175-8407 | |
(575) 209-4700 | |
(575) 404-7707 |
Full Name | |
---|---|
Type | Facility |
Speciality | Dietitian, Registered |
Location | 422 Cabernet Drive, Vine Grove, Kentucky |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1982194684 | NPI | - | NPPES |
1082987 | Other | REGISTERED DIETITIAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | 1082987 (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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9900 Spectrum Drive, Austin, TX 78717-4555 Ph: (575) 808-8844 | 422 Cabernet Drive, Vine Grove, KY 40175-8407 Ph: (575) 209-4700 |