Provider Demographics
NPI:1871481564
Name:HEWITT, MARISSA (RDN)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:HEWITT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:FALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:1197 BELVOIR LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-1443
Mailing Address - Country:US
Mailing Address - Phone:734-546-6622
Mailing Address - Fax:
Practice Address - Street 1:1197 BELVOIR LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-1443
Practice Address - Country:US
Practice Address - Phone:734-546-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered