Provider Demographics
NPI:1477692432
Name:COFFEY, CASEY DRAKE (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:DRAKE
Last Name:COFFEY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9048 LEGENDS LAKE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5258
Mailing Address - Country:US
Mailing Address - Phone:865-414-7491
Mailing Address - Fax:
Practice Address - Street 1:9048 LEGENDS LAKE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5258
Practice Address - Country:US
Practice Address - Phone:865-414-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1095133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00841OtherDMRS CONTRACT POVIDR NO.