Healthcare Provider Details

I. General information

NPI: 1356194484
Provider Name (Legal Business Name): CHRISTOPHER V BOYD RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DUPONT RD
LOUISVILLE KY
40207-4611
US

IV. Provider business mailing address

1000 DUPONT RD
LOUISVILLE KY
40207-4611
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-6500
  • Fax:
Mailing address:
  • Phone: 502-899-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number123640
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: