Provider Demographics
NPI:1518393487
Name:HAWES, COREY JOSEPH (DCN, RD, CSO, CNSC)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:JOSEPH
Last Name:HAWES
Suffix:
Gender:M
Credentials:DCN, RD, CSO, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5294 TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-8906
Mailing Address - Country:US
Mailing Address - Phone:502-797-1190
Mailing Address - Fax:
Practice Address - Street 1:403 MARQUIS AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2129
Practice Address - Country:US
Practice Address - Phone:502-797-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2567133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY831218279OtherKY TAX ID