Healthcare Provider Details

I. General information

NPI: 1134257504
Provider Name (Legal Business Name): MAE M MAUPIN-STORY R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 BOGGS LANE
RICHMOND KY
40475
US

IV. Provider business mailing address

103 LABELL DRIVE
RICHMOND KY
40475
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-7312
  • Fax: 859-626-4298
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberKY0312
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: