Provider Demographics
NPI:1063550911
Name:RENNER, LYNNETT L (RD, LDE)
Entity type:Individual
Prefix:
First Name:LYNNETT
Middle Name:L
Last Name:RENNER
Suffix:
Gender:F
Credentials:RD, LDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WHITLEY ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2626
Mailing Address - Country:US
Mailing Address - Phone:606-864-5187
Mailing Address - Fax:606-864-8295
Practice Address - Street 1:525 WHITLEY ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741
Practice Address - Country:US
Practice Address - Phone:606-864-5187
Practice Address - Fax:606-864-8295
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0625133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0059728Medicare ID - Type Unspecified