Provider Demographics
NPI:1063022440
Name:KOUGH, AUBREY MARIE (MS, RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:AUBREY
Middle Name:MARIE
Last Name:KOUGH
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:MISS
Other - First Name:AUBREY
Other - Middle Name:MARIE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 MAINE STREET
Mailing Address - Street 2:MSO LIBRARY
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1346
Mailing Address - Country:US
Mailing Address - Phone:785-505-2988
Mailing Address - Fax:785-505-5228
Practice Address - Street 1:1130 W 4TH ST STE 3200
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1346
Practice Address - Country:US
Practice Address - Phone:785-505-5885
Practice Address - Fax:785-505-5302
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1831133V00000X
KS2575133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered