Provider Demographics
NPI:1730179458
Name:PENDERGRASS, KARA FRICKE (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:FRICKE
Last Name:PENDERGRASS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MISS
Other - First Name:KARA
Other - Middle Name:SUE
Other - Last Name:PENDERGRASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:1101 WINCHESTER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4028
Mailing Address - Country:US
Mailing Address - Phone:859-225-4595
Mailing Address - Fax:859-225-4726
Practice Address - Street 1:1101 WINCHESTER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4028
Practice Address - Country:US
Practice Address - Phone:859-225-4595
Practice Address - Fax:859-225-4726
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0138133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal