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General NPI Number Information
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NPI Number | 1750206926
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Entity Type | Individual
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Provider Name | MARY SHANNON BURKHOLDER
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Gender | Female
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 1451 HARRODSBURG RD
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City | LEXINGTON
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State | KY
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Zip | 40504-3758
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Country | US
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Telephone | 859-396-9172
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 CHASEWOOD WAY
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City | LEXINGTON
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State | KY
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Zip | 40513-1728
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Country | US
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Telephone | 859-396-9172
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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 | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number | 1118
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License Number State | KY
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