MEDICARE: HEATHER BAUGHN 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	133V00000X	Registered Dietitian	5259	OH

General Provider Information

NPI Number	:	1619545860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER BAUGHN RD

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4882 E MAIN ST STE 210
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3536
Country	:	US
Telephone Number	:	614-566-0610
Fax Number	:

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

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	06/15/2021

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Directions to “ HEATHER BAUGHN RD” Practice Location

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