Provider Demographics
NPI:1184681116
Name:HAMILTON, LESLIE A (RD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:A
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2670 ROUNDTOP RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7204
Mailing Address - Country:US
Mailing Address - Phone:270-259-6400
Mailing Address - Fax:290-259-9524
Practice Address - Street 1:2670 ROUNDTOP RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7204
Practice Address - Country:US
Practice Address - Phone:270-259-6400
Practice Address - Fax:290-259-9524
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY897496133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3317866Medicare ID - Type Unspecified