Rick Loudermelt, RPH, DPH, RD, LD

Individual provider Active NPI Registered Dietitian · Williamsburg, KY

NPI 1760654073 · NPPES record last updated Nov 28, 2010

Key facts

NPI
1760654073
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
2083 (KY)
Practice address
475 N Highway 25 W
Williamsburg, KY 40769-1576
Phone
(606) 215-6352
Fax
(877) 792-5105
NPI assigned
Mar 26, 2008
Sex
Male
Sole proprietor
Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
2083KYMDClinical Social Worker
12249ALMDPharmacist
12304KYMDPharmacist
11957TNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
RL Nutrition Services Past
since Jan 1, 1990
Accepting new patients
Corner Prescription Shoppe Inc Past
since Apr 1, 2013
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 2083 KY Yes
Pharmacist 183500000X 12304 KY
Pharmacist 183500000X 11957 TN
Pharmacist 183500000X 12249 AL

Addresses

Primary practice location

475 N Highway 25 W
Williamsburg, KY 40769-1576

Mailing address

PO Box 698
Williamsburg, KY 40769-0698
Phone (606) 215-6352

Other identifiers

IdentifierTypeStateIssuer
11896924OtherCAQH

Other providers in Williamsburg, KY

All providers in Williamsburg, KY · Registered Dietitian in Kentucky

Sources for this page

Verify at the official NPI Registry.