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NPI Code Detail

MEDICARE: JARA KING BAUER RD,LD

MEDICARE: JARA KING BAUER RD,LD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianKY-1498KY

General Provider Information

NPI Number : 1578515292
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARA KING BAUER RD,LD
Provider Business Mailing Address
First Line : 55 NEAVE RIDGE RD
Second Line :
City : BROOKSVILLE
State : KY
Zip : 41004-7612
Country : US
Telephone Number : 606-735-9290
Fax Number :
Provider Business Practice Location Address
First Line : 989 MEDICAL PARK DR
Second Line :
City : MAYSVILLE
State : KY
Zip : 41056-8750
Country : US
Telephone Number : 606-759-3574
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 05/08/2024

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Directions to “ JARA KING BAUER RD,LD” Practice Location

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