Provider Demographics
NPI:1710681838
Name:LEWIS, AUDREY P (BS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:P
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 HWY 127 S
Mailing Address - Street 2:
Mailing Address - City:OWENTON
Mailing Address - State:KY
Mailing Address - Zip Code:40359
Mailing Address - Country:US
Mailing Address - Phone:502-514-7935
Mailing Address - Fax:
Practice Address - Street 1:1002 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324
Practice Address - Country:US
Practice Address - Phone:502-735-4592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY283877133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered