Provider Demographics
NPI:1760986137
Name:MEADE, NICHOLAS OTTO (DO, MS, RD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:OTTO
Last Name:MEADE
Suffix:
Gender:M
Credentials:DO, MS, RD
Other - Prefix:
Other - First Name:NICKY
Other - Middle Name:
Other - Last Name:ROTHSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:245 FOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2792
Mailing Address - Country:US
Mailing Address - Phone:859-323-6021
Mailing Address - Fax:859-323-1670
Practice Address - Street 1:245 FOUNTAIN CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2792
Practice Address - Country:US
Practice Address - Phone:859-323-6021
Practice Address - Fax:859-323-1670
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
989683133V00000X
KYFT665390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered