CASEY PROVO (NPI# 1386163707) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386163707 |
| Entity Type | Individual |
| Full Name | CASEY PROVO |
| Credential | MS, RDN, LDN |
| Practice Address |
1689 Nonconnah Blvd. Memphis TN 38132 |
| Mailing Address |
1156 West Natchez Point #72 Memphis TN 38103 |
| Practice Telephone | 9015238990 |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | 3200 | TN | Dietary & Nutritional Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1030 Jefferson Ave., Memphis, TN 38104 | 9015238990 |
| Street Address |
1689 NONCONNAH BLVD. |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38132 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164802195 | Cynthia Luaune Poole | Social Worker | 2606 Corporate Dr, Memphis, TN 38132 | 2015-06-04 |
| 1033375753 | Concentra Health Services, Inc. | Clinic/Center | 2831 Airways Blvd., Bldg. A, Suite 102, Memphis, TN 38132 | 2008-08-01 |
| 1063406676 | The Synergy Foundation, Inc. | Substance Abuse Rehabilitation Facility | 2305 Airport Interchange Avenue, Memphis, TN 38132 | 2005-09-09 |
| 1932488129 | Occupational Health Centers of The Southwest Pa | Clinic/Center | 2831 Airways Blvd, Bldg A, Ste 102, Memphis, TN 38132 | 2011-08-05 |
| 1699181461 | Stacy Triplett | Counselor | 2305 Airport Interchange Ave, Memphis, TN 38132-1002 | 2014-07-01 |
| 1174852164 | Delois Roberson | Dentist | 2781 Airways Blvd, Memphis, TN 38132-1104 | 2009-12-22 |
| 1801380985 | Javier Jackson | Physical Therapist | 2781 Airways Blvd, Memphis, TN 38132-1104 | 2018-06-21 |
| 1326499252 | Joshua Mock | Physical Therapy Assistant | 2781 Airways Blvd, Memphis, TN 38132-1104 | 2016-06-22 |
| 1295112720 | Michelle Frulla | Physical Therapy Assistant | 2781 Airways Blvd, Memphis, TN 38132-1104 | 2015-05-05 |
| 1528257425 | American Current Care, P.a. | Clinic/Center | 2831 Airways Boulevard, Building A, Suite 102, Memphis, TN 38132-1106 | 2007-10-17 |
| Find all providers in zip 38132 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962022731 | Emily Faquin | Dietitian, Registered | 880 Madison Ave Fl 5, Memphis, TN 38103-3409 | 2020-04-22 |
| 1447887435 | Leeanne Chittom Mcdonald | Dietitian, Registered | Ulps Surgery, 2nd Floor, 50 N. Dunlap, Memphis, TN 38105 | 2020-03-27 |
| 1982252524 | Whitney Nichole Trotter | Dietitian, Registered | 5578 Sweet Gum Dr, Memphis, TN 38134-6624 | 2019-08-27 |
| 1336706894 | Richard Starr | Dietitian, Registered | 1030 Jefferson Ave # Nfs120, Memphis, TN 38104-2127 | 2019-05-21 |
| 1518437235 | Margaret Bender | Dietitian, Registered | 3589 Johnwood Dr, Memphis, TN 38122-4549 | 2018-11-26 |
| 1629552633 | Leslie Carr Ely | Dietitian, Registered | 6263 Poplar Ave Ste 605, Memphis, TN 38119-4724 | 2018-09-17 |
| 1154827632 | Kristy Gibbons | Dietitian, Registered | 262 Danny Thomas Pl # Ms 732, Memphis, TN 38105-3678 | 2018-04-03 |
| 1114433943 | Abigail Currie Lenore Roche | Dietitian, Registered | 43 N Cleveland St, Memphis, TN 38104-2301 | 2017-12-15 |
| 1952848038 | Ward Dietetics, LLC | Dietitian, Registered | 4561 Sequoia Ave, Memphis, TN 38117-1719 | 2017-01-26 |
| 1053781617 | Astrid Roman | Dietitian, Registered | 8020 Hillside Cv, Memphis, MS 38119 | 2015-09-25 |
| Find all providers in MEMPHIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.