Provider Demographics
NPI:1811251606
Name:BRINCKMAN, DEBORAH A (MS, RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:A
Last Name:BRINCKMAN
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 TALKING LEAVES DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4304
Mailing Address - Country:US
Mailing Address - Phone:860-967-8996
Mailing Address - Fax:
Practice Address - Street 1:2317 TALKING LEAVES DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4304
Practice Address - Country:US
Practice Address - Phone:860-967-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006039133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered