Provider Demographics
NPI:1740574235
Name:FOWLER, KATHERINE TEAGUE (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:TEAGUE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:INGRAM
Other - Last Name:TEAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:809 HILLVIEW HTS
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2180
Mailing Address - Country:US
Mailing Address - Phone:615-934-9979
Mailing Address - Fax:
Practice Address - Street 1:2003 BLAIR BLVD
Practice Address - Street 2:STE 200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5000
Practice Address - Country:US
Practice Address - Phone:615-934-9979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2115133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered