Provider Demographics
NPI:1194797274
Name:THOMAS, MERRITT BATES (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:MERRITT
Middle Name:BATES
Last Name:THOMAS
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-0309
Mailing Address - Country:US
Mailing Address - Phone:270-686-7747
Mailing Address - Fax:270-926-9862
Practice Address - Street 1:1501 BRECKENRIDGE ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1054
Practice Address - Country:US
Practice Address - Phone:270-686-7747
Practice Address - Fax:270-926-9862
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0189133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
0282708Medicare PIN
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0282409Medicare PIN
0282611Medicare PIN
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0049219Medicare PIN