=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841133584
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMY CIACCIO KINGERY RDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2026
-----------------------------------------------------
Last Update Date | 04/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 BUSICK WELL RD
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39042-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-826-7187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 405 BUSICK WELL RD
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39042-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-826-7187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 0771
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------