Provider Demographics
NPI:1134874662
Name:MOONEY, CANDACE (MS RDN CSR LDN)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:MOONEY
Suffix:
Gender:F
Credentials:MS RDN CSR LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 BENDERS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2291
Mailing Address - Country:US
Mailing Address - Phone:615-400-8389
Mailing Address - Fax:
Practice Address - Street 1:4560 BENDERS FERRY RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-2291
Practice Address - Country:US
Practice Address - Phone:615-400-8389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1005X
1047568133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal