Provider Demographics
NPI:1740574235
Name:FOWLER, KATHERINE TEAGUE (MS, RDN, CEDS-C, LDN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:TEAGUE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MS, RDN, CEDS-C, LDN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:INGRAM
Other - Last Name:TEAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 575
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6188
Mailing Address - Country:US
Mailing Address - Phone:615-933-7662
Mailing Address - Fax:615-933-7660
Practice Address - Street 1:30 BURTON HILLS BLVD
Practice Address - Street 2:SUITE 575
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-6188
Practice Address - Country:US
Practice Address - Phone:615-933-7662
Practice Address - Fax:615-933-7660
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2115133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered