Provider Demographics
NPI:1982009221
Name:WILLIAMS, LINDA JOY (RD)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JOY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:JOY
Other - Last Name:PAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:400 E GRAY ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1740
Mailing Address - Country:US
Mailing Address - Phone:502-574-6580
Mailing Address - Fax:502-574-5286
Practice Address - Street 1:4255 HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1210
Practice Address - Country:US
Practice Address - Phone:502-485-7141
Practice Address - Fax:502-485-7145
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11266133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered