Provider Demographics
NPI:1922350198
Name:VINYARD, ALLISON BROOKE (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:BROOKE
Last Name:VINYARD
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 S FLOYD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3828
Mailing Address - Country:US
Mailing Address - Phone:270-331-3718
Mailing Address - Fax:270-415-5322
Practice Address - Street 1:145 MOLLOY CT
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-9453
Practice Address - Country:US
Practice Address - Phone:270-331-3718
Practice Address - Fax:270-415-5322
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2065133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic