Provider Demographics
NPI:1417392598
Name:NEAL, AUDREY LYNN (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:LYNN
Last Name:NEAL
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4335 BAREBACK LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5186
Mailing Address - Country:US
Mailing Address - Phone:816-332-0141
Mailing Address - Fax:
Practice Address - Street 1:4335 BAREBACK LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-5186
Practice Address - Country:US
Practice Address - Phone:816-332-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
808250133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered