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2401 New Hartford Rd Owensboro KY 42303-1312 | |
| (270) 688-5147 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dietitian, Registered |
| Location | 2401 New Hartford Rd, Owensboro, Kentucky |
| Authorized Official Name and Position | John T Hackbarth (SECERTARY) |
| Authorized Official Contact | 2704174813 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 23229 Owensboro KY 42304-3229 Ph: (270) 691-8070 | 2401 New Hartford Rd Owensboro KY 42303-1312 Ph: (270) 688-5147 |
| NPI Number | 1477914927 |
|---|---|
| Provider Enumeration Date | 03/11/2016 |
| Last Update Date | 01/03/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477914927 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (Kentucky) | Secondary |
| 133V00000X | Dietitian, Registered | (Kentucky) | Primary |
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