Provider Demographics
NPI:1003621426
Name:POYTHRESS, ALYSSA (RDN)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:POYTHRESS
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 1:2250 WILMA RUDOLPH BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8453
Mailing Address - Country:US
Mailing Address - Phone:931-257-6503
Mailing Address - Fax:
Practice Address - Street 1:2250 WILMA RUDOLPH BLVD STE F
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8453
Practice Address - Country:US
Practice Address - Phone:931-257-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4453133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty