Healthcare Provider Details

I. General information

NPI: 1750649646
Provider Name (Legal Business Name): REBECCA L REASONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EASTMORELAND AVE SUITE 335
MEMPHIS TN
38104-3519
US

IV. Provider business mailing address

1325 EASTMORELAND AVE SUITE 335
MEMPHIS TN
38104-3519
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-1199
  • Fax: 901-726-0794
Mailing address:
  • Phone: 901-726-1199
  • Fax: 901-726-0794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number2310
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: