Provider Demographics
NPI:1235694563
Name:STOOKSBURY, KAYLA MARIE (NUTRITION EDUCATOR)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:STOOKSBURY
Suffix:
Gender:F
Credentials:NUTRITION EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 HINCHEY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-3516
Mailing Address - Country:US
Mailing Address - Phone:865-828-5247
Mailing Address - Fax:
Practice Address - Street 1:185 JUSTICE CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861
Practice Address - Country:US
Practice Address - Phone:865-828-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education