Healthcare Provider Details

I. General information

NPI: 1962072397
Provider Name (Legal Business Name): MAKAYLA RENEE LOVELESS RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 MEADOWVIEW PKWY
KINGSPORT TN
37660-7475
US

IV. Provider business mailing address

712 OAK GROVE AVE
GREENEVILLE TN
37745-3920
US

V. Phone/Fax

Practice location:
  • Phone: 423-230-5000
  • Fax:
Mailing address:
  • Phone: 423-620-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: