MEDICARE: KATHERINE TEAGUE FOWLER MS, RDN, CEDS-C, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	2115	TN

General Provider Information

NPI Number	:	1740574235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE TEAGUE FOWLER MS, RDN, CEDS-C, LDN

Provider Business Mailing Address
First Line	:	30 BURTON HILLS BLVD
Second Line	:	SUITE 575
City	:	NASHVILLE
State	:	TN
Zip	:	37215-6188
Country	:	US
Telephone Number	:	615-933-7662
Fax Number	:	615-933-7660

Provider Business Practice Location Address
First Line	:	30 BURTON HILLS BLVD
Second Line	:	SUITE 575
City	:	NASHVILLE
State	:	TN
Zip	:	37215-6188
Country	:	US
Telephone Number	:	615-933-7662
Fax Number	:	615-933-7660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2011
Last Update Date	:	05/28/2024

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