Provider Demographics
NPI:1114413184
Name:MEDRANO, MEGAN (RD, LD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:397 JASON DR APT 14
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2821
Mailing Address - Country:US
Mailing Address - Phone:317-519-3926
Mailing Address - Fax:
Practice Address - Street 1:163 OLD TODDS RD STE 115
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:317-519-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86068120133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered