Provider Demographics
NPI:1508385097
Name:SOUTHERN KENTUCKY NUTRITION PROFESSIONALS
Entity Type:Organization
Organization Name:SOUTHERN KENTUCKY NUTRITION PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:EMBRY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:270-780-0118
Mailing Address - Street 1:26 FARLEY LN
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122-8616
Mailing Address - Country:US
Mailing Address - Phone:270-780-0118
Mailing Address - Fax:
Practice Address - Street 1:26 FARLEY LN
Practice Address - Street 2:
Practice Address - City:ALVATON
Practice Address - State:KY
Practice Address - Zip Code:42122-8616
Practice Address - Country:US
Practice Address - Phone:270-780-0118
Practice Address - Fax:270-780-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty