Provider Demographics
NPI:1144638495
Name:HOLTON, SHANNON INGALLS (MPH, RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:INGALLS
Last Name:HOLTON
Suffix:
Gender:F
Credentials:MPH, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 KAY RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9541
Mailing Address - Country:US
Mailing Address - Phone:252-751-9096
Mailing Address - Fax:888-457-9647
Practice Address - Street 1:201 GOVERNMENT CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8198
Practice Address - Country:US
Practice Address - Phone:252-902-2387
Practice Address - Fax:252-413-1446
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002544133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered