Healthcare Provider Details

I. General information

NPI: 1356781744
Provider Name (Legal Business Name): CORY JO TALBOTT RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LN SUITE 309
ALEXANDRIA VA
22310-3245
US

IV. Provider business mailing address

6355 WALKER LN SUITE 309
ALEXANDRIA VA
22310-3245
US

V. Phone/Fax

Practice location:
  • Phone: 703-644-4461
  • Fax: 866-212-1244
Mailing address:
  • Phone: 703-644-4461
  • Fax: 866-212-1244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number6234223
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1007882
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX3223
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: