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General NPI Number Information
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NPI Number | 1982093308
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Entity Type | Organization
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Legal Business Name | FAMILY NUTRITION SPECIALISTS
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 1989 OAK TREE CV STE B
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City | HERNANDO
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State | MS
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Zip | 38632-1536
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Country | US
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Telephone | 901-488-0681
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Fax |
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Provider Business Mailing Address
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Address Line | 1989 OAK TREE CV STE B
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City | HERNANDO
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State | MS
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Zip | 38632-1536
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Country | US
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Telephone | 901-488-0681
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RHONDA S BROOKS
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Credential |
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Telephone | 901-488-0681
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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 | D0908
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License Number State | MS
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