Healthcare Provider Details

I. General information

NPI: 1730336975
Provider Name (Legal Business Name): RL NUTRITION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 N HIGHWAY 25 W SUITE 101
WILLIAMSBURG KY
40769-1576
US

IV. Provider business mailing address

PO BOX 698
WILLIAMSBURG KY
40769-0698
US

V. Phone/Fax

Practice location:
  • Phone: 606-215-6352
  • Fax: 877-792-5105
Mailing address:
  • Phone: 606-215-6352
  • Fax: 877-792-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number2083
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number2083
License Number StateKY

VIII. Authorized Official

Name: RICK R. LOUDERMELT
Title or Position: OWNER/DIRECTOR
Credential: RPH, RD, LD, CDE
Phone: 606-258-2777