Healthcare Provider Details

I. General information

NPI: 1194434456
Provider Name (Legal Business Name): TAYLOR KOENIGS RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9469 RIVER CANE RD
MASCOT TN
37806-2154
US

IV. Provider business mailing address

9469 RIVER CANE RD
MASCOT TN
37806-2154
US

V. Phone/Fax

Practice location:
  • Phone: 865-909-7609
  • Fax: 865-240-3169
Mailing address:
  • Phone: 865-909-7609
  • Fax: 865-240-3169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: