Provider Demographics
NPI:1568449445
Name:ACEY, PAMELA JEAN (MD RD LD)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEAN
Last Name:ACEY
Suffix:
Gender:F
Credentials:MD RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1916
Mailing Address - Country:US
Mailing Address - Phone:606-678-4761
Mailing Address - Fax:606-676-9671
Practice Address - Street 1:500 BOURNE AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1916
Practice Address - Country:US
Practice Address - Phone:606-678-4761
Practice Address - Fax:606-678-2708
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0800133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20001012Medicaid
KY20023016Medicaid
KY20027017Medicaid
KY20074019Medicaid
KY20104014Medicaid
KY20901211Medicaid
KY20029013Medicaid
KY20100012Medicaid
KY20044012Medicaid
KY20901211Medicaid
KY300610Medicare PIN
KY300112Medicare PIN
Q03153Medicare UPIN
KY20100012Medicaid
KY20023016Medicaid
KY300810Medicare PIN
KY20001012Medicaid
KY20044012Medicaid
KY300710Medicare PIN
KY300212Medicare PIN