Provider Demographics
NPI:1952680555
Name:FREEMAN, SHELLEY L
Entity Type:Individual
Prefix:MISS
First Name:SHELLEY
Middle Name:L
Last Name:FREEMAN
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 1:1028 ASH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LASCASSAS
Mailing Address - State:TN
Mailing Address - Zip Code:37085-1400
Mailing Address - Country:US
Mailing Address - Phone:931-636-9466
Mailing Address - Fax:
Practice Address - Street 1:1028 ASH RIDGE RD
Practice Address - Street 2:
Practice Address - City:LASCASSAS
Practice Address - State:TN
Practice Address - Zip Code:37085-1400
Practice Address - Country:US
Practice Address - Phone:931-636-9466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT89643133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2220OtherTN LICENSE