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General NPI Number Information
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NPI Number | 1700763372
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Entity Type | Organization
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Legal Business Name | DBLK SPORTS & WELLNESS MANAGEMENT
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 1501 KIRBY RD
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City | KNOXVILLE
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State | TN
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Zip | 37909-2854
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Country | US
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Telephone | 865-272-9718
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Fax |
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Provider Business Mailing Address
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Address Line | 8208 NUBBIN RIDGE DR
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City | KNOXVILLE
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State | TN
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Zip | 37919-8476
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Country | US
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Telephone | 865-474-0211
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | ANDREA KENDRICK
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Credential | RD
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Telephone | 865-474-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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