Provider Demographics
NPI:1770377632
Name:ALLEN, LAURA ANNE (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNE
Last Name:ALLEN
Suffix:
Gender:
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LENA CT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-0510
Mailing Address - Country:US
Mailing Address - Phone:859-948-5357
Mailing Address - Fax:
Practice Address - Street 1:101 LENA CT
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-0510
Practice Address - Country:US
Practice Address - Phone:859-948-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY123588133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered