Healthcare Provider Details

I. General information

NPI: 1598794497
Provider Name (Legal Business Name): DIETITIAN ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 FENNELL PL
NESBIT MS
38651-7400
US

IV. Provider business mailing address

2065 FENNELL PL
NESBIT MS
38651-7400
US

V. Phone/Fax

Practice location:
  • Phone: 901-759-9337
  • Fax:
Mailing address:
  • Phone: 901-759-9337
  • Fax: 901-759-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LINDA M PENNINGTON
Title or Position: VICE PRESIDENT
Credential: RD
Phone: 901-759-9337