Provider Demographics
NPI:1457751174
Name:KENTUCKY ONE HEALTH
Entity Type:Organization
Organization Name:KENTUCKY ONE HEALTH
Other - Org Name:SAINT JOSEPH HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:REGISTERED/LICENSED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DURALL
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:859-219-0530
Mailing Address - Street 1:1 SAINT JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3742
Mailing Address - Country:US
Mailing Address - Phone:859-313-1000
Mailing Address - Fax:859-219-0721
Practice Address - Street 1:3251 BEAUMONT CIRCLE
Practice Address - Street 2:SAINT JOSEPH HEALTHY LIFESTYLE CENTER
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513
Practice Address - Country:US
Practice Address - Phone:859-219-0530
Practice Address - Fax:859-219-0721
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENTUCKY ONE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0948133V00000X, 251S00000X, 281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No281P00000XHospitalsChronic Disease HospitalGroup - Multi-Specialty