Provider Demographics
NPI:1093917650
Name:BOTTOMS, LAURA ELIZABETH (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:BOTTOMS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 RAYMOND STILLWELL RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:KY
Mailing Address - Zip Code:42716-8539
Mailing Address - Country:US
Mailing Address - Phone:502-428-6354
Mailing Address - Fax:
Practice Address - Street 1:289 IRELAND AVE
Practice Address - Street 2:BLDG 851
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-5111
Practice Address - Country:US
Practice Address - Phone:502-624-9834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2001133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered