Provider Demographics
NPI:1629482393
Name:SHEWCRAFT, ALI (RD)
Entity Type:Individual
Prefix:MS
First Name:ALI
Middle Name:
Last Name:SHEWCRAFT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BRECKENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1054
Mailing Address - Country:US
Mailing Address - Phone:270-686-7747
Mailing Address - Fax:270-926-9862
Practice Address - Street 1:1600 BRECKENRIDGE ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1055
Practice Address - Country:US
Practice Address - Phone:270-686-7744
Practice Address - Fax:270-926-8677
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86031418133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered