Provider Demographics
NPI:1376230193
Name:MATHERLEY, REBECCA BEALL (MS, RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:BEALL
Last Name:MATHERLEY
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:REBECCA
Other - Last Name:BEALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 CUMBERLAND ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1907
Mailing Address - Country:US
Mailing Address - Phone:423-698-0802
Mailing Address - Fax:
Practice Address - Street 1:425 CUMBERLAND ST STE 110
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1907
Practice Address - Country:US
Practice Address - Phone:423-698-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN86083622133V00000X
TN3412133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered