Provider Demographics
NPI:1932411279
Name:SKINNER-LUCAS, STEPHANIE EDWINA (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:EDWINA
Last Name:SKINNER-LUCAS
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:E
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MA, RD, LDN
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:
Practice Address - Street 1:555 RACE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2347
Practice Address - Country:US
Practice Address - Phone:855-699-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003175133V00000X
FL10945133V00000X
KY247514133V00000X
NCL003071133V00000X
WV701133V00000X
CT002360133V00000X
TN0000002420133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered