Healthcare Provider Details

I. General information

NPI: 1720983711
Provider Name (Legal Business Name): JULIA TEDDER NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 FOREST OAKS DR
FOREST VA
24551-1929
US

IV. Provider business mailing address

1068 MIDDLE VIEW DR
FOREST VA
24551-4594
US

V. Phone/Fax

Practice location:
  • Phone: 980-295-6388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIA TEDDER
Title or Position: NUTRITIONIST
Credential: CNS
Phone: 980-295-6388