Provider Demographics
NPI:1477358794
Name:WADE, TYLER STEVEN (RD, RDN)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:STEVEN
Last Name:WADE
Suffix:
Gender:
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 WETTERAU AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1508
Mailing Address - Country:US
Mailing Address - Phone:270-268-4805
Mailing Address - Fax:
Practice Address - Street 1:1018 WETTERAU AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1508
Practice Address - Country:US
Practice Address - Phone:270-268-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37004053A133V00000X
KY244771133VN1201X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management