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NPI Code Detail

MEDICARE: COURTNEY W LILES MS, RDN, LDN

MEDICARE: COURTNEY W LILES MS, RDN, LDN
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
1133V00000XRegistered Dietitian3768TN

General Provider Information

NPI Number : 1205769940
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY W LILES MS, RDN, LDN
Provider Business Mailing Address
First Line : 327 E BURWELL AVE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37917-5006
Country : US
Telephone Number : 423-650-8971
Fax Number :
Provider Business Practice Location Address
First Line : 327 E BURWELL AVE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37917-5006
Country : US
Telephone Number : 423-650-8971
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2026
Last Update Date : 06/03/2026

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