Provider Demographics
NPI:1598478380
Name:BARRY, JADE M (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:M
Last Name:BARRY
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:M
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:580 HAYNES RD
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375-4015
Mailing Address - Country:US
Mailing Address - Phone:931-636-9829
Mailing Address - Fax:
Practice Address - Street 1:580 HAYNES RD
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-4015
Practice Address - Country:US
Practice Address - Phone:931-636-9829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2366133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered