Provider Demographics
NPI:1932637972
Name:PRESTON, UVALYNE DIANE (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:UVALYNE
Middle Name:DIANE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HAZARD VA CLINIC
Mailing Address - Street 2:210 BLACK GOLD BLVD., SUITE 107
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701
Mailing Address - Country:US
Mailing Address - Phone:606-436-2350
Mailing Address - Fax:
Practice Address - Street 1:210 BLACK GOLD BLVD., SUITE 107
Practice Address - Street 2:HAZARD VA CLINIC
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:606-436-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY124641133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY697026OtherREGISTERED DIETITIAN
KY124641OtherLICENSED DIETITIAN