MEDICARE: ANNA GRACE CARSTENS RDN, LDN, MPH

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
2	133V00000X	Registered Dietitian	L006332	NC

General Provider Information

NPI Number	:	1366170706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA GRACE CARSTENS RDN, LDN, MPH

Provider Business Mailing Address
First Line	:	122 LEGGO AVE
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-2757
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 LEGGO AVE
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-2757
Country	:	US
Telephone Number	:	229-200-3950
Fax Number	:

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	12/18/2025

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