Healthcare Provider Details

I. General information

NPI: 1154142206
Provider Name (Legal Business Name): KIRBIE GRACE DAILY MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4907 MARIANNE LN
MEMPHIS TN
38117-6615
US

IV. Provider business mailing address

4907 MARIANNE LN
MEMPHIS TN
38117-6615
US

V. Phone/Fax

Practice location:
  • Phone: 831-840-2326
  • Fax:
Mailing address:
  • Phone: 831-840-2326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: