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NPI Code Detail

MEDICARE: BOBBIE JEAN CALHOUN LD

MEDICARE: BOBBIE JEAN CALHOUN LD
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
1133N00000XNutritionistD0144MS

General Provider Information

NPI Number : 1780635870
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOBBIE JEAN CALHOUN LD
Provider Business Mailing Address
First Line : 510 HIGHWAY 322
Second Line :
City : CLARKSDALE
State : MS
Zip : 38614-4717
Country : US
Telephone Number : 662-624-4292
Fax Number : 662-624-4354
Provider Business Practice Location Address
First Line : 800 OHIO AVE
Second Line :
City : CLARKSDALE
State : MS
Zip : 38614-7200
Country : US
Telephone Number : 662-624-2504
Fax Number : 662-627-3629
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2006
Last Update Date : 07/08/2007

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Directions to “ BOBBIE JEAN CALHOUN LD” Practice Location

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