Provider Demographics
NPI:1518268705
Name:BURSI, LEXANN PATE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LEXANN
Middle Name:PATE
Last Name:BURSI
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MISS
Other - First Name:LEXANN
Other - Middle Name:TOMINELLO
Other - Last Name:PATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9215 MILLBRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-1423
Mailing Address - Country:US
Mailing Address - Phone:662-548-8075
Mailing Address - Fax:
Practice Address - Street 1:9215 MILLBRANCH RD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1423
Practice Address - Country:US
Practice Address - Phone:662-548-8075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001989133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered