Provider Demographics
NPI:1740730332
Name:ULLERY, KATHERINE (RD,LD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ULLERY
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MOSS VIEW ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-5535
Mailing Address - Country:US
Mailing Address - Phone:270-781-8039
Mailing Address - Fax:270-796-8946
Practice Address - Street 1:1109 STATE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2648
Practice Address - Country:US
Practice Address - Phone:270-781-8039
Practice Address - Fax:270-796-8946
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169284133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered