Provider Demographics
NPI:1912431958
Name:RALEIGH, ANGELA (RD,LD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RALEIGH
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:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-0329
Mailing Address - Country:US
Mailing Address - Phone:606-767-1048
Mailing Address - Fax:
Practice Address - Street 1:955 HIGHWAY 30 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-7846
Practice Address - Country:US
Practice Address - Phone:606-666-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1176133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered