Provider Demographics
NPI:1659993830
Name:THOMAS, DAVID TRAVIS (PHD, RDN, CSSD, FAND)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TRAVIS
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHD, RDN, CSSD, FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SOUTH LIMESTONE 209H CTW BUILDING
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-218-0863
Mailing Address - Fax:
Practice Address - Street 1:836 TIFFANIE CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-4082
Practice Address - Country:US
Practice Address - Phone:859-218-0863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY123101133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics