Provider Demographics
NPI:1114287604
Name:GREGORY, TARA H (MPH,RD,LDN)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:H
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MPH,RD,LDN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:A
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-0129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-3324
Practice Address - Country:US
Practice Address - Phone:919-742-5641
Practice Address - Fax:919-742-7496
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003953133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered