Provider Demographics
NPI:1326409483
Name:LYSAGHT, MOLLY (RDN, LD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:LYSAGHT
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:THURMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4211
Mailing Address - Fax:615-425-4201
Practice Address - Street 1:10477 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-1941
Practice Address - Country:US
Practice Address - Phone:513-202-8283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD7094133V00000X
OH1036875133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered