Provider Demographics
NPI:1245456888
Name:BURRIER, BRENDA L (LICENSED DIETITIAN)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:L
Last Name:BURRIER
Suffix:
Gender:F
Credentials:LICENSED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2116
Mailing Address - Country:US
Mailing Address - Phone:859-987-1915
Mailing Address - Fax:859-987-3230
Practice Address - Street 1:341 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2116
Practice Address - Country:US
Practice Address - Phone:859-987-1915
Practice Address - Fax:859-987-3230
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0468133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20009015Medicaid
KY20009015Medicaid
KYP73260Medicare UPIN