Provider Demographics
NPI:1508918160
Name:BKK NUTRITION CONSULTING
Entity Type:Organization
Organization Name:BKK NUTRITION CONSULTING
Other - Org Name:FOOD AND NUTRITION PROFESSIONALS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KASTAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, MS, CDE
Authorized Official - Phone:502-891-0360
Mailing Address - Street 1:125 CHENOWETH LN
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2641
Mailing Address - Country:US
Mailing Address - Phone:502-891-0360
Mailing Address - Fax:502-891-0360
Practice Address - Street 1:125 CHENOWETH LN
Practice Address - Street 2:SUITE 207
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2641
Practice Address - Country:US
Practice Address - Phone:502-891-0360
Practice Address - Fax:502-891-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0025133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY176894OtherANTHEM BLUE CROSS BLUE SH
KY10654330662OtherHUMANA
KY6300003OtherUNITED HEALTH
KY176894OtherANTHEM BLUE CROSS BLUE SH
P58688Medicare UPIN