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General NPI Number Information
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NPI Number | 1023639051
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Entity Type | Individual
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Provider Name | ALEXANDRA JOE DEPRIEST RD, LD
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Gender | Female
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Dates
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Enumeration Date | 04/30/2020
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 250 E LIBERTY ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1530
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Country | US
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Telephone | 502-587-4465
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Fax |
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Provider Business Mailing Address
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Address Line | 228 RING RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-3436
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Country | US
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Telephone | 502-718-1135
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number | 245493
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License Number State | KY
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