Individual
MISS BRENDA SUE DEBORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.,R.D.,L.D.,C.D.
Contact information
Practice address
800 ZORN AVE, LOUISVILLE, KY 40206-1433
(502) 287-4513
Mailing address
7216 HILL PARK WAY, APT. 256, LOUISVILLE, KY 40220-7155
(502) 458-3510
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
KY-0595
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37000155A
CERTIFIED DIETITIAN
IN
01
—
KY-0595
LICENSED DIETITIAN
KY
Enumeration date
07/02/2008
Last updated
07/02/2008
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