Provider Demographics
NPI:1407239197
Name:KING, NADINE RONNIE (PHD, RDN, LDN)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:RONNIE
Last Name:KING
Suffix:
Gender:F
Credentials:PHD, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6437 MASSEY ESTATES CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-1403
Mailing Address - Country:US
Mailing Address - Phone:901-763-0940
Mailing Address - Fax:
Practice Address - Street 1:6437 MASSEY ESTATES CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1403
Practice Address - Country:US
Practice Address - Phone:901-763-0940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000189133V00000X
MSD1418133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered