Provider Demographics
NPI:1477863868
Name:LYKINS, BRIDGET L (RD)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:L
Last Name:LYKINS
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 1:130 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-1265
Mailing Address - Country:US
Mailing Address - Phone:606-564-9447
Mailing Address - Fax:606-564-4483
Practice Address - Street 1:130 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-1265
Practice Address - Country:US
Practice Address - Phone:606-564-9447
Practice Address - Fax:606-564-4483
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY802610133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered