Provider Demographics
NPI:1265894026
Name:NUTRITION THERAPY SPECIALIST, LLC
Entity type:Organization
Organization Name:NUTRITION THERAPY SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:502-494-8149
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency