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General NPI Number Information
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NPI Number | 1477358794
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Entity Type | Individual
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Provider Name | TYLER STEVEN WADE RD, RDN
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Gender | Male
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 1018 WETTERAU AVE
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City | LOUISVILLE
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State | KY
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Zip | 40217-1508
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Country | US
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Telephone | 270-268-4805
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Fax |
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Provider Business Mailing Address
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Address Line | 1018 WETTERAU AVE
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City | LOUISVILLE
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State | KY
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Zip | 40217-1508
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Country | US
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Telephone | 270-268-4805
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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 | 37004053A
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License Number State | IN
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Taxonomy #2
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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 | 244771
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 244771
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License Number State | KY
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