Provider Demographics
NPI:1164296059
Name:CAMPBELL, AYANNA (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:AYANNA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:AYANNA
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:2459 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-2714
Mailing Address - Country:US
Mailing Address - Phone:901-859-7216
Mailing Address - Fax:
Practice Address - Street 1:2459 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-2714
Practice Address - Country:US
Practice Address - Phone:901-859-7216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered