Provider Demographics
NPI:1982817557
Name:MCADAMS, TRACI RENEE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:RENEE
Last Name:MCADAMS
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 1:135 GRANDVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-9154
Mailing Address - Country:US
Mailing Address - Phone:502-494-8149
Mailing Address - Fax:502-531-0049
Practice Address - Street 1:135 GRANDVIEW WAY
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-9154
Practice Address - Country:US
Practice Address - Phone:502-494-8149
Practice Address - Fax:502-531-0049
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0601133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered