Provider Demographics
NPI:1699292946
Name:BEVINS CROWLEY NUTRITION LLC
Entity type:Organization
Organization Name:BEVINS CROWLEY NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:BEVINS
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:502-316-8776
Mailing Address - Street 1:1122 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8853
Mailing Address - Country:US
Mailing Address - Phone:502-316-8776
Mailing Address - Fax:
Practice Address - Street 1:640 E LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1719
Practice Address - Country:US
Practice Address - Phone:502-316-8776
Practice Address - Fax:502-316-8776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
629957133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
629957OtherREGISTERED DIETITIAN
KY122376OtherKENTUCKY LICENSURE FOR DIETITIANS