Provider Demographics
NPI:1588986012
Name:O'NEILL, CARA JANE (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:CARA
Middle Name:JANE
Last Name:O'NEILL
Suffix:
Gender:F
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 1:400 PROFESSIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1147
Mailing Address - Country:US
Mailing Address - Phone:859-744-4482
Mailing Address - Fax:859-744-0338
Practice Address - Street 1:400 PROFESSIONAL AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1147
Practice Address - Country:US
Practice Address - Phone:859-744-4482
Practice Address - Fax:859-744-0338
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY85007162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1889OtherKY DIETICIANS AND NUTRITIONISTS LICENSE
KY85007162OtherNPI
KYK099720OtherINDIVIDUAL PTAN (MEDICARE)