Provider Demographics
NPI:1407875115
Name:BENTLEY, KATHY JEFFRIES (RD)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JEFFRIES
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 MCPHERSON DR # A
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-3527
Mailing Address - Country:US
Mailing Address - Phone:615-469-2288
Mailing Address - Fax:
Practice Address - Street 1:712 MCPHERSON DR # A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-3527
Practice Address - Country:US
Practice Address - Phone:615-469-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered