Provider Demographics
NPI:1376803700
Name:HAYNES, NICHOLE L (MS, RD, CSR, LDN)
Entity Type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:L
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MS, RD, CSR, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ANTLER RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-4743
Mailing Address - Country:US
Mailing Address - Phone:615-513-3131
Mailing Address - Fax:615-354-1809
Practice Address - Street 1:242 ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3246
Practice Address - Country:US
Practice Address - Phone:615-354-0053
Practice Address - Fax:615-354-1809
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1486133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal