Provider Demographics
NPI:1821060906
Name:MASON, DONNA JO (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JO
Last Name:MASON
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-0309
Mailing Address - Country:US
Mailing Address - Phone:270-686-7747
Mailing Address - Fax:270-926-9862
Practice Address - Street 1:218 W MCELROY ST
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-1447
Practice Address - Country:US
Practice Address - Phone:270-389-1230
Practice Address - Fax:270-389-9031
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0537133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
0049220Medicare PIN
0282410Medicare PIN
0282709Medicare PIN
0282313Medicare PIN
0282612Medicare PIN
0282809Medicare PIN
0282513Medicare PIN