Provider Demographics
NPI:1871777458
Name:BROOKS, LINDA SUE (MS, RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 HARRODSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3704
Mailing Address - Country:US
Mailing Address - Phone:859-313-4297
Mailing Address - Fax:859-313-3132
Practice Address - Street 1:2195 HARRODSBURG RD STE 125
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3504
Practice Address - Country:US
Practice Address - Phone:859-323-2232
Practice Address - Fax:859-257-0659
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY123514133V00000X
KYKY-0300133V00000X
KY171063133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered