Healthcare Provider Details

I. General information

NPI: 1861734667
Provider Name (Legal Business Name): WELLFIT NUTRITION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
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: 731-300-3372
  • Fax: 731-300-3374
Mailing address:
  • Phone: 731-300-3372
  • Fax: 731-300-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2501
License Number StateTN

VIII. Authorized Official

Name: CATHERINE M DRAPER
Title or Position: REGISTERED DIETICIAN
Credential: RD
Phone: 731-300-3372