Provider Demographics
NPI:1467081794
Name:MUSICK, ANN MARIE (CN)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:MUSICK
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 PAVILION PKWY STE 215
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2891
Mailing Address - Country:US
Mailing Address - Phone:859-363-5945
Mailing Address - Fax:
Practice Address - Street 1:187 PAVILION PKWY STE 215
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2891
Practice Address - Country:US
Practice Address - Phone:859-363-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252465133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist