Provider Demographics
NPI:1871752873
Name:NUTRITION ADVISORS OF KENTUCKIANA,PLLC
Entity type:Organization
Organization Name:NUTRITION ADVISORS OF KENTUCKIANA,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,LD
Authorized Official - Phone:502-507-5430
Mailing Address - Street 1:3075 N SAINT FRANCIS RD
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:KY
Mailing Address - Zip Code:40037-8164
Mailing Address - Country:US
Mailing Address - Phone:502-507-5430
Mailing Address - Fax:502-348-0040
Practice Address - Street 1:6400 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3340
Practice Address - Country:US
Practice Address - Phone:502-587-9660
Practice Address - Fax:502-540-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0622133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty