Provider Demographics
NPI:1629422621
Name:WHITHAM, KIRA
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:WHITHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 DEVON VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-3100
Mailing Address - Country:US
Mailing Address - Phone:503-887-6228
Mailing Address - Fax:
Practice Address - Street 1:2548 DEVON VALLEY DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-3100
Practice Address - Country:US
Practice Address - Phone:503-887-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-16
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education