Provider Demographics
NPI:1245011287
Name:BOLDEN, GENIESE TRESS (RDN)
Entity type:Individual
Prefix:MRS
First Name:GENIESE
Middle Name:TRESS
Last Name:BOLDEN
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 1:5447 GLENWILD CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5942
Mailing Address - Country:US
Mailing Address - Phone:901-218-3853
Mailing Address - Fax:
Practice Address - Street 1:5447 GLENWILD CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5942
Practice Address - Country:US
Practice Address - Phone:901-218-3853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4647133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty