Healthcare Provider Details

I. General information

NPI: 1487833257
Provider Name (Legal Business Name): MARIE ELLEN KEITH MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160C W TENNESSEE AVE
OAK RIDGE TN
37830-6501
US

IV. Provider business mailing address

160C W TENNESSEE AVE
OAK RIDGE TN
37830-6501
US

V. Phone/Fax

Practice location:
  • Phone: 865-835-3790
  • Fax:
Mailing address:
  • Phone: 865-835-3790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1953
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: