MEDICARE: MR. KEVIN RICHIE MS, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian	246526	KY

General Provider Information

NPI Number	:	1093355042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN RICHIE MS, RD

Provider Business Mailing Address
First Line	:	653 MONTCLAIR DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-2274
Country	:	US
Telephone Number	:	812-786-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	653 MONTCLAIR DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-2274
Country	:	US
Telephone Number	:	812-786-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	01/07/2020

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