Provider Demographics
NPI:1093355042
Name:RICHIE, KEVIN (MS, RD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:RICHIE
Suffix:
Gender:M
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2274
Mailing Address - Country:US
Mailing Address - Phone:812-786-5700
Mailing Address - Fax:
Practice Address - Street 1:653 MONTCLAIR DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2274
Practice Address - Country:US
Practice Address - Phone:812-786-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246526