MEDICARE: MS. JERRI RENEE CASSADA RD, LDN, CDE

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	133V00000X	Registered Dietitian	LDN1444	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LDN1444	OTHER	TN	LICENSE

General Provider Information

NPI Number	:	1144201310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JERRI RENEE CASSADA RD, LDN, CDE

Provider Business Mailing Address
First Line	:	114 TRAIL RIDGE WAY
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-2189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 24TH AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-2637
Country	:	US
Telephone Number	:	615-873-7204
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/26/2024

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