SUSAN ELIZABETH WALLACE


Address: 102 Carran Dr, Lakeside Park, KY 41017-2233
Phone: 8593312939

SUSAN ELIZABETH WALLACE (NPI# 1376842732) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1376842732
Entity Type Individual
Full Name SUSAN ELIZABETH WALLACE
Credential R,D., L.D.
Practice Address 102 Carran Dr
Lakeside Park
KY 41017-2233
Practice Telephone 8593312939
Mailing Telephone 8593312939
Enumeration Date 2011-03-23
Last Update Date 2011-03-23
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 133V00000X Dietitian, Registered KY-1998 KY Dietary & Nutritional Service Providers

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1952426025 Susan Wallace Acupuncturist 1009 Solano Ave, # A, Albany, CA 94706-1617 2007-03-20
1447375662 Susan D. Wallace Counselor 166 Pawtucket Avenue, Pawtucket, RI 02860-3811 2007-03-20
1639554769 Susan Wallace Physical Therapist 35 Medical Center Pkwy, Augusta, ME 04330-8160 2015-07-30
1740537687 Susan R Wallace Nurse Practitioner 100 Methodist Blvd, Hattiesburg, MS 39402-1295 2012-08-09
1710247812 Susan Victoria Wallace Marriage & Family Therapist 9685 Hayes St, Riverside, CA 92503-3660 2012-05-22
1427203462 Susan Marie Wallace Occupational Therapist 355 Oak Grove Rd, Spartanburg, SC 29301-2537 2008-11-18
1194985887 Susan Jean Wallace Registered Nurse E Hwy 18, Pine Ridge, SD 57770-1201 2008-06-16

Office Location

Street Address 102 CARRAN DR
City LAKESIDE PARK
State KY
Zip Code 41017-2233

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1578187209 St. Elizabeth Medical Center, Inc. Pharmacy 1 Medical Village Dr., Edgewood, KY 41017 2020-05-28
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1396396750 Family First Vision Care Kentucky Optometrist 614 Buttermilk Pike, Fort Mitchell, KY 41017 2019-09-26
1083184543 Katie Franconia Smith Nurse Practitioner 2865 Chancellor Dr., Crestview Hills, KY 41017 2018-11-27
1871077511 Janet Reeves Martin Nurse Practitioner Infinity Dialysis, 4750 East Galbraith Rd. Suite 103, Cincinnati, OH 41017 2018-09-19
1144713983 Kelly Wiechart Dentist 599 Freedom Park Dr Ste 100, Crestview Hills, KY 41017 2018-06-06
1225535966 Proscan Radiology Northern Kentucky, LLC Radiology 350 Thomas More Pkwy Ste 170, Crestview Hills, KY 41017 2018-04-10
1396241626 Tressa S. Leahy Physical Therapist 200 Medical Village Drive, Edgewood, KY 41017 2018-04-04
1699294470 Raymond Gardinier Physical Therapist 3755 Old Ky 17, Fort Wright, KY 41017 2017-09-13
1992229785 Adrienne Bussard Physician Assistant 334 Thomas More Pkwy Ste 120, Crestview Hills, KY 41017 2017-08-02
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Taxonomy Information

Taxonomy Code 133V00000X
Grouping Dietary & Nutritional Service Providers
Classification Dietitian, Registered

Taxonomy Definition

A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration.
Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997.

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1851908727 Laura Elizabeth Dean Dietitian, Registered 411 E Chestnut St Ste 544, Louisville, KY 40202-1713 2020-09-25
1629684907 Jaclyn Vaughn Moore Dietitian, Registered 234 E Gray St Ste 164, Louisville, KY 40202-1903 2020-09-22
1790391118 Elizabeth Marie Riddle Dietitian, Registered 4955 Norton Healthcare Blvd Ste 102, Louisville, KY 40241-2832 2020-09-21
1386259471 Ethan Mattingly Dietitian, Registered 175 Thad Redman Rd, Payneville, KY 40157-7524 2020-09-15
1801401294 Elizabeth Bell Dietitian, Registered 241 Franck Ave, Louisville, KY 40206-2544 2020-09-11
1033722855 Britanii P Mcwhorter Dietitian, Registered 770 Roberts Rd, Campbellsville, KY 42718-6740 2020-08-31
1245843291 Lindsay Gabbard Dietitian, Registered 115 Eddie Dr, Mount Vernon, KY 40456-7574 2020-08-28
1134732183 Tracey True Dietitian, Registered 880 Sandstone Rdg, Cold Spring, KY 41076-7119 2020-08-28
1194342519 Joella Crowder Dietitian, Registered 15 Shannon Ln, Somerset, KY 42503-4958 2020-07-01
1982221305 Rebecca Jean Lyons Dietitian, Registered 741 Frozen Crk, Raccoon, KY 41557-8506 2020-07-01
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Competitor

Search similar providers

City LAKESIDE PARK
Zip Code 41017

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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