Provider Demographics
NPI:1891478855
Name:GATLIN, REBECCA (RD, CPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GATLIN
Suffix:
Gender:F
Credentials:RD, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 MASTERS WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-8586
Mailing Address - Country:US
Mailing Address - Phone:270-670-7699
Mailing Address - Fax:
Practice Address - Street 1:622 MASTERS WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-8586
Practice Address - Country:US
Practice Address - Phone:270-670-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered