Provider Demographics
NPI:1023791043
Name:GOLDEN, DEANNA ANTONIA (MS, RD)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:ANTONIA
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:ANTONIA
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1013 PARHAM PL
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LAMONT ST & VETERANS WAY
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86198322OtherCOMMISSION ON DIETETIC REGISTRATION