Provider Demographics
NPI:1891059762
Name:GISH, JILL ANN (RD, LD)
Entity Type:Individual
Prefix:
First Name:JILL ANN
Middle Name:
Last Name:GISH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 STEEPRUN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6508
Mailing Address - Country:US
Mailing Address - Phone:502-303-4087
Mailing Address - Fax:
Practice Address - Street 1:6811 STEEPRUN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6508
Practice Address - Country:US
Practice Address - Phone:502-303-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2255133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered