Provider Demographics
NPI:1134831910
Name:BECK, MICHELLE (RD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:
Practice Address - Street 1:1512 S DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-7030
Practice Address - Country:US
Practice Address - Phone:502-530-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1827133V00000X
IA118517133V00000X
DEDN-0011040133V00000X
LA3575133V00000X
OHLD.10076133V00000X
OK2819133V00000X
MS2420133V00000X
KY291166133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered