Provider Demographics
NPI:1477119410
Name:FARIA, DESTIN NICHOLE (MHS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:DESTIN
Middle Name:NICHOLE
Last Name:FARIA
Suffix:
Gender:F
Credentials:MHS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 MOUNT DR APT 424
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37876-3128
Mailing Address - Country:US
Mailing Address - Phone:864-775-2163
Mailing Address - Fax:
Practice Address - Street 1:293 MOUNT DR APT 424
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37876-3128
Practice Address - Country:US
Practice Address - Phone:864-775-2163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4011133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty