Healthcare Provider Details

I. General information

NPI: 1033460415
Provider Name (Legal Business Name): CATHERINE MARY DRAPER MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EXECUTIVE DR
JACKSON TN
38305-2318
US

IV. Provider business mailing address

101 EXECUTIVE DR
JACKSON TN
38305-2318
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-3373
  • Fax: 731-300-3374
Mailing address:
  • Phone: 731-300-3373
  • Fax: 731-300-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN0000002501
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: