Provider Demographics
NPI:1992959738
Name:CARNEY, PATRICIA LYNNE (RD,LD, CDE)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LYNNE
Last Name:CARNEY
Suffix:
Gender:F
Credentials:RD,LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PARKWAY
Mailing Address - Street 2:SUITE 129
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223
Mailing Address - Country:US
Mailing Address - Phone:502-412-3253
Mailing Address - Fax:502-412-3202
Practice Address - Street 1:2700 STANLEY GAULT PARKWAY
Practice Address - Street 2:SUITE 129
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223
Practice Address - Country:US
Practice Address - Phone:502-412-3253
Practice Address - Fax:502-412-3202
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1385133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered