Healthcare Provider Details

I. General information

NPI: 1174277024
Provider Name (Legal Business Name): GRAYSON LEIGH HULL RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 FRENCH LANDING DR
NASHVILLE TN
37228-1501
US

IV. Provider business mailing address

210 CAUREL LN
LITTLE ROCK AR
72223-5266
US

V. Phone/Fax

Practice location:
  • Phone: 615-925-3894
  • Fax:
Mailing address:
  • Phone: 901-870-0516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1995
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1995
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: