Provider Demographics
NPI:1245424514
Name:PEARSON, KANDY M (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:KANDY
Middle Name:M
Last Name:PEARSON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 AMANDA DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7813
Mailing Address - Country:US
Mailing Address - Phone:865-482-7052
Mailing Address - Fax:
Practice Address - Street 1:109 AMANDA DR
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7813
Practice Address - Country:US
Practice Address - Phone:865-482-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000693133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered