Provider Demographics
NPI:1891465936
Name:RUPP, TRACEY-LEIGH (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY-LEIGH
Middle Name:
Last Name:RUPP
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 1:2001 RED JACKET TRCE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-5170
Mailing Address - Country:US
Mailing Address - Phone:615-516-0628
Mailing Address - Fax:
Practice Address - Street 1:2001 RED JACKET TRCE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-5170
Practice Address - Country:US
Practice Address - Phone:615-516-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3460133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered