Provider Demographics
NPI:1255301792
Name:MCGINN, CAROLYN J (RD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:MCGINN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-9657
Mailing Address - Country:US
Mailing Address - Phone:606-638-4389
Mailing Address - Fax:606-638-3008
Practice Address - Street 1:1080 MEADOWBROOK LN
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-9657
Practice Address - Country:US
Practice Address - Phone:606-638-4389
Practice Address - Fax:606-638-3008
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9216Medicare ID - Type Unspecified
0921601Medicare UPIN