Provider Demographics
NPI:1972168151
Name:LEWIS, NATASHIA P (RDN, LD, CLC)
Entity Type:Individual
Prefix:MRS
First Name:NATASHIA
Middle Name:P
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RDN, LD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 E ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-4554
Mailing Address - Country:US
Mailing Address - Phone:662-378-7264
Mailing Address - Fax:
Practice Address - Street 1:310 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-3614
Practice Address - Country:US
Practice Address - Phone:662-378-7264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1706133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered