Provider Demographics
NPI:1760019202
Name:HUSSEY, TAYLOR ALEXANDRIA (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ALEXANDRIA
Last Name:HUSSEY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E TREMONT AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5483
Mailing Address - Country:US
Mailing Address - Phone:336-906-9369
Mailing Address - Fax:
Practice Address - Street 1:301 E TREMONT AVE APT 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5483
Practice Address - Country:US
Practice Address - Phone:336-906-9369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005836133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered