Healthcare Provider Details

I. General information

NPI: 1992358881
Provider Name (Legal Business Name): CHANDLER WILLIS RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANDLER ROGERS RD, LDN

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 PARK WEST BLVD STE 508
KNOXVILLE TN
37923-4313
US

IV. Provider business mailing address

PO BOX 52948
KNOXVILLE TN
37950-2948
US

V. Phone/Fax

Practice location:
  • Phone: 865-694-9676
  • Fax: 865-588-3742
Mailing address:
  • Phone: 865-306-5700
  • Fax: 865-584-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3668
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: