Provider Demographics
NPI:1780160895
Name:COLTHARP, JENNIFER (RD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:COLTHARP
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 WALDEN DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-4225
Mailing Address - Country:US
Mailing Address - Phone:615-936-3952
Mailing Address - Fax:615-936-3956
Practice Address - Street 1:1211 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-1320
Practice Address - Country:US
Practice Address - Phone:615-936-3952
Practice Address - Fax:615-936-3956
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2312133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLDN0000002312OtherTN RD LICENSE NUMBER