Provider Demographics
NPI:1770629107
Name:YOUNCE, CHERYL (RD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:YOUNCE
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 1:283 GOBLE ST
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-7967
Mailing Address - Country:US
Mailing Address - Phone:606-886-2788
Mailing Address - Fax:606-886-7989
Practice Address - Street 1:283 GOBLE ST
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-7967
Practice Address - Country:US
Practice Address - Phone:606-886-2788
Practice Address - Fax:606-886-7989
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20036018Medicaid
KY0631509Medicare PIN