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General NPI Number Information
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NPI Number | 1275754509
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Entity Type | Individual
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Provider Name | TERESA THAUT RD,LD,CD,CNSD
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 3010 TAYLOR SPRINGS DR
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City | LOUISVILLE
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State | KY
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Zip | 40220-1506
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Country | US
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Telephone | 502-458-4588
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Fax |
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | KY-05-1872
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D-755
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License Number State | ID
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