Provider Demographics
NPI:1518851690
Name:KANNAN, PRATHIMA RAMASWAMI (RDN)
Entity type:Individual
Prefix:
First Name:PRATHIMA
Middle Name:RAMASWAMI
Last Name:KANNAN
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 1:5325 OAK BEND CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2202
Mailing Address - Country:US
Mailing Address - Phone:251-610-0458
Mailing Address - Fax:
Practice Address - Street 1:5325 OAK BEND CT
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2202
Practice Address - Country:US
Practice Address - Phone:251-610-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9599133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered