Healthcare Provider Details

I. General information

NPI: 1952142382
Provider Name (Legal Business Name): HEATHER BUMBALOUGH RDN, LDN, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 21ST AVE N
NASHVILLE TN
37203-1804
US

IV. Provider business mailing address

711 KENT RD
NASHVILLE TN
37214-3545
US

V. Phone/Fax

Practice location:
  • Phone: 615-649-3046
  • Fax:
Mailing address:
  • Phone: 937-407-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2918
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: