Provider Demographics
NPI:1295311066
Name:SPICKARD, CARISSA HOPE (RDN, LD)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:HOPE
Last Name:SPICKARD
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 SYLVAN PARK LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4973
Mailing Address - Country:US
Mailing Address - Phone:205-994-0421
Mailing Address - Fax:
Practice Address - Street 1:326 SYLVAN PARK LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4973
Practice Address - Country:US
Practice Address - Phone:205-994-0421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005422133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered