Provider Demographics
NPI:1003008996
Name:OMOHUNDRO, MELISSA (RD, LD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:OMOHUNDRO
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:164 ACORN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4489
Mailing Address - Country:US
Mailing Address - Phone:859-227-8448
Mailing Address - Fax:
Practice Address - Street 1:164 ACORN FALLS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4489
Practice Address - Country:US
Practice Address - Phone:859-227-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-KY-1928133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered