Provider Demographics
NPI:1336911320
Name:DAVIS, CAITLIN ANNE
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1072 ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-5815
Mailing Address - Country:US
Mailing Address - Phone:865-304-9874
Mailing Address - Fax:
Practice Address - Street 1:1072 ISLAND DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-5815
Practice Address - Country:US
Practice Address - Phone:865-304-9874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered