Provider Demographics
NPI:1013382720
Name:PHILLIPS, TONYA (MA,RD,LDN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 N MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28705-6502
Mailing Address - Country:US
Mailing Address - Phone:828-688-2104
Mailing Address - Fax:828-688-1334
Practice Address - Street 1:11728 S 226 HWY
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-8954
Practice Address - Country:US
Practice Address - Phone:828-766-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001487133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC859231OtherCOMMISSION ON DIETETIC REGISTRATION
NCL001487OtherNC BOARD OF DIETETICS/NUTRITION