Healthcare Provider Details

I. General information

NPI: 1700154465
Provider Name (Legal Business Name): WHITNEY ANGEL THORNTON R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 SANDSTONE CIR SUITE E
JACKSON TN
38305-2098
US

IV. Provider business mailing address

36 SANDSTONE CIR SUITE E
JACKSON TN
38305-2098
US

V. Phone/Fax

Practice location:
  • Phone: 731-446-3885
  • Fax:
Mailing address:
  • Phone: 731-446-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN0000002037
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: