Provider Demographics
NPI:1154581320
Name:PERRY, STEPHEN DOUGLAS (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:PERRY
Suffix:
Gender:M
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 KY HIGHWAY 1842 E
Mailing Address - Street 2:
Mailing Address - City:SADIEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40370-9036
Mailing Address - Country:US
Mailing Address - Phone:502-863-7167
Mailing Address - Fax:
Practice Address - Street 1:1741 KY HIGHWAY 1842 E
Practice Address - Street 2:
Practice Address - City:SADIEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40370-9036
Practice Address - Country:US
Practice Address - Phone:502-863-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2049133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered