Healthcare Provider Details

I. General information

NPI: 1437831146
Provider Name (Legal Business Name): FLANNERY JANE DAUGHTRY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 OLD HICKORY BLVD STE 150
BRENTWOOD TN
37027-5387
US

IV. Provider business mailing address

2490 TITANS LN
BRENTWOOD TN
37027-3731
US

V. Phone/Fax

Practice location:
  • Phone: 615-925-3894
  • Fax: 615-658-8420
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD2439
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD006664
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4661
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: