Provider Demographics
NPI:1790036168
Name:LEE, TERESA M (RD, LD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:LEE
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 1:4359 NEW SHEPHERDSVILLE RD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-8000
Mailing Address - Country:US
Mailing Address - Phone:502-350-5494
Mailing Address - Fax:502-350-5820
Practice Address - Street 1:4359 NEW SHEPHERDSVILLE RD
Practice Address - Street 2:SUITE 245
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-8000
Practice Address - Country:US
Practice Address - Phone:502-350-5494
Practice Address - Fax:502-350-5820
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2424133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered