Individual
MS. MARY A CHEATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
3720 RAIKES HILL RD, ELK HORN, KY 42733-9717
(270) 789-0625
Mailing address
3720 RAIKES HILL RD, ELK HORN, KY 42733-9717
(270) 789-0625
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
KY-1119
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20001012
—
KY
05
—
20023016
—
KY
05
—
20027017
—
KY
05
—
20029013
—
KY
05
—
20044012
—
KY
05
—
20074019
—
KY
05
—
20100012
—
KY
05
—
20104014
—
KY
05
—
20109013
—
KY
05
—
20116018
—
KY
05
—
20901211
—
KY
Enumeration date
06/24/2008
Last updated
08/27/2009
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