MEDICARE: ALEX GARDNER NUTRITION, LLC

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

General Provider Information

NPI Number	:	1437857828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEX GARDNER NUTRITION, LLC

Provider Business Mailing Address
First Line	:	6829 MOUNTAIN SHADOW DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-6317
Country	:	US
Telephone Number	:	865-214-7055
Fax Number	:	833-524-5200

Provider Business Practice Location Address
First Line	:	6829 MOUNTAIN SHADOW DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-6317
Country	:	US
Telephone Number	:	865-659-1696
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALEXANDRA RENEA NUSSBAUMER GARDNER
Credential	:	RDN
Telephone Number	:	865-659-1696

Provider Enumeration Date	:	02/16/2023
Last Update Date	:	05/25/2026

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