Provider Demographics
NPI:1134792344
Name:GOGEL, EMILY (RDN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GOGEL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CRUMBAUGH RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9706
Mailing Address - Country:US
Mailing Address - Phone:859-608-4789
Mailing Address - Fax:
Practice Address - Street 1:3167 CUSTER DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4018
Practice Address - Country:US
Practice Address - Phone:859-208-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY272084133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered