Provider Demographics
NPI:1255649174
Name:PETERSON, JULIE HAYES (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:HAYES
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SHEFFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-8558
Mailing Address - Country:US
Mailing Address - Phone:859-513-0441
Mailing Address - Fax:
Practice Address - Street 1:229 CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3209
Practice Address - Country:US
Practice Address - Phone:859-623-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2155133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered