Provider Demographics
NPI:1265584866
Name:GRAYBILL, EDITH CRACE (RD,LD)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:CRACE
Last Name:GRAYBILL
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7639 IRONWORKS RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-7603
Mailing Address - Country:US
Mailing Address - Phone:859-842-4459
Mailing Address - Fax:
Practice Address - Street 1:1594 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3704
Practice Address - Country:US
Practice Address - Phone:859-313-4297
Practice Address - Fax:859-313-3132
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1389133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0081103Medicare ID - Type UnspecifiedREGISTRED DIETITIAN