Provider Demographics
NPI:1487833257
Name:KEITH, MARIE ELLEN (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELLEN
Last Name:KEITH
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 1:160C W TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6501
Mailing Address - Country:US
Mailing Address - Phone:865-835-3790
Mailing Address - Fax:
Practice Address - Street 1:160C W TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6501
Practice Address - Country:US
Practice Address - Phone:865-835-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1953133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered