1750913745 NPI number — ALLISON HAYNES REGISTERED DIETITIAN

Table of content: ALLISON HAYNES REGISTERED DIETITIAN (NPI 1750913745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750913745 NPI number — ALLISON HAYNES REGISTERED DIETITIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYNES
Provider First Name:
ALLISON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED DIETITIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750913745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1804 HIGHWAY 45 BYP STE 604
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38305-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-660-7971
Provider Business Mailing Address Fax Number:
731-660-8739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 JACKSON WALK PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38301-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-425-6964
Provider Business Practice Location Address Fax Number:
731-425-6927
Provider Enumeration Date:
02/07/2020

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:  3167 , 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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