Healthcare Provider Details

I. General information

NPI: 1780479899
Provider Name (Legal Business Name): ALLEGRA TUCKER MPH, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 FAIRVIEW RD
CHARLOTTE NC
28210-3321
US

IV. Provider business mailing address

6633 FAIRVIEW RD
CHARLOTTE NC
28210-3321
US

V. Phone/Fax

Practice location:
  • Phone: 704-336-1264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86448587
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: