Healthcare Provider Details

I. General information

NPI: 1871777458
Provider Name (Legal Business Name): LINDA SUE BROOKS MS, RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 HARRODSBURG RD STE 125
LEXINGTON KY
40504-3504
US

IV. Provider business mailing address

1594 HARRODSBURG RD
LEXINGTON KY
40504-3704
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-2232
  • Fax: 859-257-0659
Mailing address:
  • Phone: 859-313-4297
  • Fax: 859-313-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number123514
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberKY-0300
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number171063
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: