Provider Demographics
NPI:1295207116
Name:HIXSON, STELLA A (MED, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:A
Last Name:HIXSON
Suffix:
Gender:F
Credentials:MED, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 FLORATON RD
Mailing Address - Street 2:
Mailing Address - City:READYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37149-4615
Mailing Address - Country:US
Mailing Address - Phone:615-890-3609
Mailing Address - Fax:
Practice Address - Street 1:1014 S CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-3704
Practice Address - Country:US
Practice Address - Phone:931-474-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000496133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered