Provider Demographics
NPI:1245902923
Name:POVINELLI, ABBY (RDN)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:POVINELLI
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 1:2490 TITANS LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3731
Mailing Address - Country:US
Mailing Address - Phone:615-925-3894
Mailing Address - Fax:615-658-8420
Practice Address - Street 1:750 OLD HICKORY BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5387
Practice Address - Country:US
Practice Address - Phone:615-658-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4110133V00000X
IN37003767A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ071828Medicaid