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General NPI Number Information
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NPI Number | 1811363880
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Entity Type | Individual
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Provider Name | CORY EAKINS MS, RDN, LDN
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Gender | Male
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Dates
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Enumeration Date | 08/13/2015
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Last Update Date | 08/11/2018
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Provider Practice Location Address
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Address Line | 2223 S MAIN ST
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City | MADISONVILLE
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State | KY
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Zip | 42431
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Country | US
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Telephone | 270-836-9221
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Fax |
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Provider Business Mailing Address
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Address Line | 2223 S MAIN ST
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City | MADISONVILLE
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State | KY
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Zip | 42431-3307
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Country | US
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Telephone | 270-836-9221
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | BDNDDN00221541
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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 | BDNDDN00221541
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License Number State | KY
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