Healthcare Provider Details

I. General information

NPI: 1255301792
Provider Name (Legal Business Name): CAROLYN J MCGINN R.D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 MEADOWBROOK LN
LOUISA KY
41230-9657
US

IV. Provider business mailing address

1080 MEADOWBROOK LN
LOUISA KY
41230-9657
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-4389
  • Fax: 606-638-3008
Mailing address:
  • Phone: 606-638-4389
  • Fax: 606-638-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberKY-0210
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: