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NPI Code Detail

MEDICARE: LEXSTART NUTRITION, LLC

MEDICARE: LEXSTART NUTRITION, LLC
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
1133V00000XRegistered Dietitian166670KY

General Provider Information

NPI Number : 1942715776
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEXSTART NUTRITION, LLC
Provider Business Mailing Address
First Line : 320 LEBEAU DR
Second Line :
City : NICHOLASVILLE
State : KY
Zip : 40356-7104
Country : US
Telephone Number : 859-494-2561
Fax Number :
Provider Business Practice Location Address
First Line : 90 SOUTHPORT DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40503-1819
Country : US
Telephone Number : 859-429-8935
Fax Number :
Authorized Official
Title or Position : OWNER/REGISTERED DIETITIAN
Name : MRS. EMILY DICKENS MCGLONE
Credential : MS, RD, LD, CLT
Telephone Number : 859-429-8935
Provider Enumeration Date : 12/01/2017
Last Update Date : 12/01/2017

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Directions to “LEXSTART NUTRITION, LLC ” Practice Location

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