Provider Demographics
NPI:1255209706
Name:BOONE, SONJIA MECHELLE (RDN, LD)
Entity type:Individual
Prefix:MS
First Name:SONJIA
Middle Name:MECHELLE
Last Name:BOONE
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:MS
Other - First Name:MECHELLE
Other - Middle Name:SIMMONS
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:1054 BOONE RD
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-9706
Mailing Address - Country:US
Mailing Address - Phone:601-597-4992
Mailing Address - Fax:
Practice Address - Street 1:124 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3914
Practice Address - Country:US
Practice Address - Phone:601-597-4992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS806663133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty