Provider Demographics
NPI:1003400862
Name:CLEMENTS, OLIVIA (RDN)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 CHARLES RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:RED BOILING SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37150-6246
Mailing Address - Country:US
Mailing Address - Phone:931-787-3710
Mailing Address - Fax:
Practice Address - Street 1:361 CHARLES RUSSELL RD
Practice Address - Street 2:
Practice Address - City:RED BOILING SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37150-6246
Practice Address - Country:US
Practice Address - Phone:931-787-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered