Provider Demographics
NPI:1609601251
Name:GALLOWAY, ANDREA ALLEN (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ALLEN
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11033 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-8904
Mailing Address - Country:US
Mailing Address - Phone:606-694-5090
Mailing Address - Fax:
Practice Address - Street 1:11033 MEADOW LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-8904
Practice Address - Country:US
Practice Address - Phone:606-694-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1466133V00000X
KY293831133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered