Provider Demographics
NPI:1326667858
Name:SUTHERLAND, RIAN B (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:RIAN
Middle Name:B
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 KASINGER LN
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2529
Mailing Address - Country:US
Mailing Address - Phone:270-993-2187
Mailing Address - Fax:
Practice Address - Street 1:3663 KASINGER LN
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2529
Practice Address - Country:US
Practice Address - Phone:270-993-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY711670133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered