Provider Demographics
NPI:1275732752
Name:PENNINGTON, LINDA MOORE (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MOORE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38027-0081
Mailing Address - Country:US
Mailing Address - Phone:901-759-9337
Mailing Address - Fax:901-759-7967
Practice Address - Street 1:591 MERRIWEATHER DR
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-1685
Practice Address - Country:US
Practice Address - Phone:901-759-9337
Practice Address - Fax:901-759-7967
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR918133V00000X
MSD0936133V00000X
TN772133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
103I713623OtherMEDICARE PTAN