MEDICARE: PATRICIA DUNN HARRIS RD, LD, CDE

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	133V00000X	Registered Dietitian	KY-0195	KY

General Provider Information

NPI Number	:	1194836569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA DUNN HARRIS RD, LD, CDE

Provider Business Mailing Address
First Line	:	PO BOX 909
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40201-0909
Country	:	US
Telephone Number	:	502-588-3400
Fax Number	:	502-588-3401

Provider Business Practice Location Address
First Line	:	601 S FLOYD ST
Second Line	:	STE 403
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1837
Country	:	US
Telephone Number	:	502-588-3400
Fax Number	:	502-588-3401

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/09/2014

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