Provider Demographics
NPI:1295945012
Name:HICKLIN, RUBY LEE (RD LD)
Entity type:Individual
Prefix:MS
First Name:RUBY
Middle Name:LEE
Last Name:HICKLIN
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 1:1025 BELL DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2333
Mailing Address - Country:US
Mailing Address - Phone:270-871-9650
Mailing Address - Fax:270-825-3198
Practice Address - Street 1:3010 TAYLOR SPRINGS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1506
Practice Address - Country:US
Practice Address - Phone:502-458-4588
Practice Address - Fax:502-458-4240
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0519133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered