Provider Demographics
NPI:1154464824
Name:WRIGHT, REBECCA (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:WRIGHT
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 1:1630 MALLORY CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:KY
Mailing Address - Zip Code:42076-9430
Mailing Address - Country:US
Mailing Address - Phone:270-436-6361
Mailing Address - Fax:
Practice Address - Street 1:716 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2546
Practice Address - Country:US
Practice Address - Phone:270-762-1834
Practice Address - Fax:270-762-1823
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3322840Medicare ID - Type UnspecifiedMNT MEDICARE PROVIDER #