Provider Demographics
NPI:1770773483
Name:ANDERSON, NANCY M TARR (RN,RD,LD,CDE)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M TARR
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN,RD,LD,CDE
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:MARGARET
Other - Last Name:TARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6823 GLEN ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-7009
Mailing Address - Country:US
Mailing Address - Phone:859-371-6639
Mailing Address - Fax:
Practice Address - Street 1:901 KENTON STATION DR
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9609
Practice Address - Country:US
Practice Address - Phone:606-759-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-29
Last Update Date:2007-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0884133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic