MEDICARE: LAURA LYNN IACONO RD CDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1004X	Pediatric Nutrition Registered Dietitian	834048	IL
2	133N00000X	Nutritionist	001919	NY
3	133V00000X	Registered Dietitian	3950	TN
4	133NN1002X	Nutrition Education Nutritionist	001919	NY

General Provider Information

NPI Number	:	1003020462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LYNN IACONO RD CDN

Provider Business Mailing Address
First Line	:	170 E MAIN ST STE D127
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-2587
Country	:	US
Telephone Number	:	615-854-3243
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 HAYES ST STE 545
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2655
Country	:	US
Telephone Number	:	629-401-4494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	11/25/2025

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