Provider Demographics
NPI:1275039034
Name:ADCOCK, VICKI KENNERLY (MHS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:KENNERLY
Last Name:ADCOCK
Suffix:
Gender:F
Credentials:MHS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 HIAWASSEE ST APT W302
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2814
Mailing Address - Country:US
Mailing Address - Phone:828-505-5535
Mailing Address - Fax:
Practice Address - Street 1:37 HIAWASSEE ST APT W302
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2814
Practice Address - Country:US
Practice Address - Phone:828-505-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002214133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered