Healthcare Provider Details

I. General information

NPI: 1154236107
Provider Name (Legal Business Name): EMILY ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 DALEWOOD DR
MOBILE AL
36608-1530
US

IV. Provider business mailing address

323 DALEWOOD DR
MOBILE AL
36608-1530
US

V. Phone/Fax

Practice location:
  • Phone: 251-599-9030
  • Fax:
Mailing address:
  • Phone: 251-599-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2821
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI2366
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN9135
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86043761
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberMED-NUTR-LIC-174592
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: