Provider Demographics
NPI:1689487829
Name:BARTOLO, RUTH ANN (RD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:BARTOLO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1903 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7105
Mailing Address - Country:US
Mailing Address - Phone:270-444-8183
Mailing Address - Fax:270-444-8147
Practice Address - Street 1:1903 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7105
Practice Address - Country:US
Practice Address - Phone:270-444-8183
Practice Address - Fax:270-444-8147
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY122148133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered