Provider Demographics
NPI:1235327040
Name:COX, BRANDY NICHOLE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:NICHOLE
Last Name:COX
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MISS
Other - First Name:BRANDY
Other - Middle Name:NICHOLE
Other - Last Name:BASHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 RIVERMONT DR
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-3028
Mailing Address - Country:US
Mailing Address - Phone:931-474-1374
Mailing Address - Fax:
Practice Address - Street 1:1559 SPARTA ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1316
Practice Address - Country:US
Practice Address - Phone:931-815-4146
Practice Address - Fax:931-815-4730
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000001190133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered