Provider Demographics
NPI:1528228558
Name:FARRIS, RUTH W (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:W
Last Name:FARRIS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 IVANHOE RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-5928
Mailing Address - Country:US
Mailing Address - Phone:901-372-6982
Mailing Address - Fax:
Practice Address - Street 1:6025 WALNUT GROVE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2131
Practice Address - Country:US
Practice Address - Phone:901-226-3749
Practice Address - Fax:901-226-5453
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000120133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered