Provider Demographics
NPI:1639712144
Name:MINCEY, MEGAN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MINCEY
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 1:475 SWANHOLME DR APT I105
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-1549
Mailing Address - Country:US
Mailing Address - Phone:423-342-1803
Mailing Address - Fax:
Practice Address - Street 1:2002 EASTLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-1705
Practice Address - Country:US
Practice Address - Phone:615-697-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN86081884133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered