Healthcare Provider Details

I. General information

NPI: 1376230193
Provider Name (Legal Business Name): REBECCA BEALL MATHERLEY MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHARLOTTE REBECCA BEALL

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CUMBERLAND ST STE 110
CHATTANOOGA TN
37404-1907
US

IV. Provider business mailing address

425 CUMBERLAND ST STE 110
CHATTANOOGA TN
37404-1907
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-0802
  • Fax:
Mailing address:
  • Phone: 423-698-0802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86083622
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number3412
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: