Provider Demographics
NPI:1336186170
Name:MCNUTT, SALLY M (RD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:M
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:M
Other - Last Name:HOLTGREWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:STE 120
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-562-6783
Mailing Address - Fax:502-562-6777
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-562-6503
Practice Address - Fax:502-562-6504
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1925133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered