Provider Demographics
NPI:1780828491
Name:FORD, CHERYL DENISE (RD, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DENISE
Last Name:FORD
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 LONE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CALVERT CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42029-8320
Mailing Address - Country:US
Mailing Address - Phone:270-395-8396
Mailing Address - Fax:
Practice Address - Street 1:3430 LONE VALLEY RD
Practice Address - Street 2:
Practice Address - City:CALVERT CITY
Practice Address - State:KY
Practice Address - Zip Code:42029-8320
Practice Address - Country:US
Practice Address - Phone:270-395-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1807133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered