Healthcare Provider Details

I. General information

NPI: 1235694563
Provider Name (Legal Business Name): KAYLA MARIE STOOKSBURY NUTRITION EDUCATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 JUSTICE CENTER DRIVE
RUTLEDGE TN
37861
US

IV. Provider business mailing address

382 HINCHEY HOLLOW RD
JEFFERSON CITY TN
37760-3516
US

V. Phone/Fax

Practice location:
  • Phone: 865-828-5247
  • Fax:
Mailing address:
  • Phone: 865-828-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: