Healthcare Provider Details

I. General information

NPI: 1619129970
Provider Name (Legal Business Name): MARY GRAY HIXSON MPH, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY GRAY HUTCHISON

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 LAKE BOONE TRL STE 100
RALEIGH NC
27607-6685
US

IV. Provider business mailing address

2800 BLUE RIDGE RD SUITE 300
RALEIGH NC
27607-6478
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-7874
  • Fax:
Mailing address:
  • Phone: 919-784-7874
  • Fax: 919-784-2708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL003135
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberL003135
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: