Provider Demographics
NPI:1588021612
Name:TALLENT, RICKELLE (RD, LD)
Entity Type:Individual
Prefix:
First Name:RICKELLE
Middle Name:
Last Name:TALLENT
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E FLAMINGO RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5122
Mailing Address - Country:US
Mailing Address - Phone:702-382-8841
Mailing Address - Fax:702-369-2370
Practice Address - Street 1:2121 E FLAMINGO RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5122
Practice Address - Country:US
Practice Address - Phone:702-382-8841
Practice Address - Fax:702-369-2370
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV38071DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered