MEDICARE: ELIZABETH ANN HARRISON RD, 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
1	133VN1004X	Pediatric Nutrition Registered Dietitian	4827	TN

General Provider Information

NPI Number	:	1417891821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN HARRISON RD, LDN

Provider Business Mailing Address
First Line	:	5979 ASHLEY RD
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-6909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5979 ASHLEY RD
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-6909
Country	:	US
Telephone Number	:	901-359-3966
Fax Number	:

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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