Provider Demographics
NPI:1073887139
Name:PYLE, MARY GWENDOLYN (RD, CD, LD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GWENDOLYN
Last Name:PYLE
Suffix:
Gender:F
Credentials:RD, CD, LD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:GWENDOLYN
Other - Last Name:PYLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD, CD
Mailing Address - Street 1:3010 TAYLOR SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1587
Mailing Address - Country:US
Mailing Address - Phone:502-458-4588
Mailing Address - Fax:502-458-4240
Practice Address - Street 1:3010 TAYLOR SPRINGS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1587
Practice Address - Country:US
Practice Address - Phone:502-458-4588
Practice Address - Fax:502-458-4240
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0316133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered