Provider Demographics
NPI:1558683532
Name:SHOOPMAN, REBEKAH R
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:R
Last Name:SHOOPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SARA LEIGH DR APT 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 SARA LEIGH DR
Practice Address - Street 2:APT 1
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2635
Practice Address - Country:US
Practice Address - Phone:859-661-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2135133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist