1740574235 NPI number — KATHERINE TEAGUE FOWLER MS, RDN, CEDS-C, LDN

Table of content: KATHERINE TEAGUE FOWLER MS, RDN, CEDS-C, LDN (NPI 1740574235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740574235 NPI number — KATHERINE TEAGUE FOWLER MS, RDN, CEDS-C, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOWLER
Provider First Name:
KATHERINE
Provider Middle Name:
TEAGUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RDN, CEDS-C, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TEAGUE
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
INGRAM
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740574235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 BURTON HILLS BLVD
Provider Second Line Business Mailing Address:
SUITE 575
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-6188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-933-7662
Provider Business Mailing Address Fax Number:
615-933-7660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 BURTON HILLS BLVD
Provider Second Line Business Practice Location Address:
SUITE 575
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37215-6188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-933-7662
Provider Business Practice Location Address Fax Number:
615-933-7660
Provider Enumeration Date:
06/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  2115 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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