Provider Demographics
NPI:1932076262
Name:BOATNER, CHLOE FRAZIER (RDN)
Entity type:Individual
Prefix:MRS
First Name:CHLOE
Middle Name:FRAZIER
Last Name:BOATNER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1384 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:MYRTLE
Mailing Address - State:MS
Mailing Address - Zip Code:38650-8504
Mailing Address - Country:US
Mailing Address - Phone:662-486-4171
Mailing Address - Fax:
Practice Address - Street 1:1384 COUNTY ROAD 14
Practice Address - Street 2:
Practice Address - City:MYRTLE
Practice Address - State:MS
Practice Address - Zip Code:38650-8504
Practice Address - Country:US
Practice Address - Phone:662-486-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-21
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-2277133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered