Healthcare Provider Details

I. General information

NPI: 1639786908
Provider Name (Legal Business Name): LAUREN SHAW TINKEY MS,RDN,LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 SAM NEWELL RD STE 204
MATTHEWS NC
28105-7594
US

IV. Provider business mailing address

PO BOX 604050
CHARLOTTE NC
28260-4050
US

V. Phone/Fax

Practice location:
  • Phone: 980-202-6643
  • Fax: 980-246-9482
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberL006230
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL006230
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: