Provider Demographics
NPI:1902558844
Name:HOWARD, ELIZABETH M (RD, LD, CLC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:HOWARD
Suffix:
Gender:F
Credentials:RD, LD, CLC
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 1157
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-1157
Mailing Address - Country:US
Mailing Address - Phone:270-781-8039
Mailing Address - Fax:270-796-8946
Practice Address - Street 1:1109 STATE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2648
Practice Address - Country:US
Practice Address - Phone:270-781-2490
Practice Address - Fax:270-781-0241
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260964133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered