Provider Demographics
NPI:1760976237
Name:GAULT, DENEEN KIMBERLY
Entity Type:Individual
Prefix:
First Name:DENEEN
Middle Name:KIMBERLY
Last Name:GAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MORGAN LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1580
Mailing Address - Country:US
Mailing Address - Phone:615-828-8501
Mailing Address - Fax:
Practice Address - Street 1:25 MORGAN LN
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1580
Practice Address - Country:US
Practice Address - Phone:615-828-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education