Provider Demographics
NPI:1649222456
Name:ANDERSON, KAREN RENKEN (RD, LD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RENKEN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:SUE
Other - Last Name:RENKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:313 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-1319
Mailing Address - Country:US
Mailing Address - Phone:615-792-1911
Mailing Address - Fax:615-792-0619
Practice Address - Street 1:313 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1319
Practice Address - Country:US
Practice Address - Phone:615-792-1911
Practice Address - Fax:615-792-0619
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN00005133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered