Provider Demographics
NPI:1275943409
Name:VALLEROY, TRACEY (RD)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:VALLEROY
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 1:146 SYLVAN CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-8818
Mailing Address - Country:US
Mailing Address - Phone:270-796-8698
Mailing Address - Fax:
Practice Address - Street 1:146 SYLVAN CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-8818
Practice Address - Country:US
Practice Address - Phone:270-796-8698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2586133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered