Provider Demographics
NPI:1710338967
Name:CHELTON, STEPHANIE M (RDN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:CHELTON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:615-425-4201
Practice Address - Street 1:123 NORTHCREEK BLVD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1998
Practice Address - Country:US
Practice Address - Phone:615-851-5860
Practice Address - Fax:615-866-1272
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2667133V00000X, 136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered