Provider Demographics
NPI:1194521856
Name:FECK, LAURA NICOLE (RD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:NICOLE
Last Name:FECK
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 CHELSEA LN
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3056
Mailing Address - Country:US
Mailing Address - Phone:859-489-1739
Mailing Address - Fax:
Practice Address - Street 1:188 CHELSEA LN
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3056
Practice Address - Country:US
Practice Address - Phone:859-489-1739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY287534133V00000X
TN4935133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered