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NPI Code Detail

MEDICARE: MRS. CARA JANE O'NEILL MS, RD, LD

MEDICARE: MRS. CARA JANE O'NEILL MS, 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 Dietitian85007162KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3K099720OTHERKYINDIVIDUAL PTAN (MEDICARE)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11889OTHERKYKY DIETICIANS AND NUTRITIONISTS LICENSE
285007162OTHERKYNPI

General Provider Information

NPI Number : 1588986012
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CARA JANE O'NEILL MS, RD, LD
Provider Business Mailing Address
First Line : 400 PROFESSIONAL AVE
Second Line :
City : WINCHESTER
State : KY
Zip : 40391-1147
Country : US
Telephone Number : 859-744-4482
Fax Number : 859-744-0338
Provider Business Practice Location Address
First Line : 400 PROFESSIONAL AVE
Second Line :
City : WINCHESTER
State : KY
Zip : 40391-1147
Country : US
Telephone Number : 859-744-4482
Fax Number : 859-744-0338
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2010
Last Update Date : 07/09/2014

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