Provider Demographics
NPI:1760770598
Name:VOLL, CONNIE KAY (DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:KAY
Last Name:VOLL
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 CENTRAL AVE
Mailing Address - Street 2:1115
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4890
Mailing Address - Country:US
Mailing Address - Phone:901-278-3831
Mailing Address - Fax:901-726-1848
Practice Address - Street 1:1437 CENTRAL AVE
Practice Address - Street 2:1115
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4890
Practice Address - Country:US
Practice Address - Phone:901-278-3831
Practice Address - Fax:901-726-1848
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN914133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNUNKNOWNOtherHEALTH PLANS