Provider Demographics
NPI:1952142382
Name:BUMBALOUGH, HEATHER (RDN, LDN, NBC-HWC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BUMBALOUGH
Suffix:
Gender:F
Credentials:RDN, LDN, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 KENT RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3545
Mailing Address - Country:US
Mailing Address - Phone:937-407-5141
Mailing Address - Fax:
Practice Address - Street 1:326 21ST AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1804
Practice Address - Country:US
Practice Address - Phone:615-649-3046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
TN2918133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171400000XOther Service ProvidersHealth & Wellness Coach