Provider Demographics
NPI:1437110186
Name:PARDUE, JOSEPH CHRISTIAN (RD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CHRISTIAN
Last Name:PARDUE
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 CAMP BETTY HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:WALKERTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27051-9103
Mailing Address - Country:US
Mailing Address - Phone:336-595-8601
Mailing Address - Fax:
Practice Address - Street 1:190 KIMEL PARK DR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6946
Practice Address - Country:US
Practice Address - Phone:336-768-3296
Practice Address - Fax:336-760-5484
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC870940133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered