Healthcare Provider Details

I. General information

NPI: 1144760653
Provider Name (Legal Business Name): WHITNEY RICH RD, CSP, LD, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 BERBERICH DR
FLORENCE KY
41042-3275
US

IV. Provider business mailing address

10826 ARCARO LN
UNION KY
41091-9201
US

V. Phone/Fax

Practice location:
  • Phone: 859-992-0515
  • Fax:
Mailing address:
  • Phone: 859-992-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number121399
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: