Provider Demographics
NPI:1558482059
Name:RODGERS, TONI G (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:G
Last Name:RODGERS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 ASHLEY WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2844
Mailing Address - Country:US
Mailing Address - Phone:859-278-3853
Mailing Address - Fax:859-257-7848
Practice Address - Street 1:151 OPPORTUNITY WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-2611
Practice Address - Country:US
Practice Address - Phone:859-514-4039
Practice Address - Fax:859-231-6205
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0222133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered