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NPI Code Detail

MEDICARE: DEVON RAE MILLSAPS MS, RD, LDN

MEDICARE: DEVON RAE MILLSAPS MS, 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
1133V00000XRegistered Dietitian3508TN

General Provider Information

NPI Number : 1942886296
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEVON RAE MILLSAPS MS, RD, LDN
Provider Business Mailing Address
First Line : 1604 GREENBRIER RIDGE WAY APT 303
Second Line :
City : KNOXVILLE
State : TN
Zip : 37909-3393
Country : US
Telephone Number : 865-228-4114
Fax Number :
Provider Business Practice Location Address
First Line : 705 GATE LN STE 202
Second Line :
City : KNOXVILLE
State : TN
Zip : 37909-3521
Country : US
Telephone Number : 865-585-2677
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2021
Last Update Date : 03/18/2021

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