Healthcare Provider Details

I. General information

NPI: 1306453006
Provider Name (Legal Business Name): REFRESH NUTRITION INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2020
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N CEDAR BLUFF RD STE 550
KNOXVILLE TN
37923-3607
US

IV. Provider business mailing address

408 N CEDAR BLUFF RD STE 550
KNOXVILLE TN
37923-3607
US

V. Phone/Fax

Practice location:
  • Phone: 805-870-5588
  • Fax:
Mailing address:
  • Phone: 805-870-5588
  • Fax: 805-512-8522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: KELLEY MAY MESA
Title or Position: REGISTERED DIETITIAN
Credential: MS, RD
Phone: 805-870-5588