Healthcare Provider Details

I. General information

NPI: 1063037737
Provider Name (Legal Business Name): LAUREL DAWN AKERS RD CSG LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 S PRESTON ST FL 1
LOUISVILLE KY
40203-2319
US

IV. Provider business mailing address

216 MERCER AVE
HARRODSBURG KY
40330-9291
US

V. Phone/Fax

Practice location:
  • Phone: 502-584-3338
  • Fax: 502-584-3380
Mailing address:
  • Phone: 859-613-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number124027
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: