Provider Demographics
NPI:1972004505
Name:DAVIS, LINDSEY LEIGH (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:LEIGH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6301
Mailing Address - Country:US
Mailing Address - Phone:479-226-1286
Mailing Address - Fax:
Practice Address - Street 1:600 E UNAKA AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4035
Practice Address - Country:US
Practice Address - Phone:479-226-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003184133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered