Provider Demographics
NPI:1982478848
Name:CHILDERS, SARA TALLEY (RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:TALLEY
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:NICOLE
Other - Last Name:TALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-0049
Mailing Address - Country:US
Mailing Address - Phone:662-212-3241
Mailing Address - Fax:
Practice Address - Street 1:1506 MAGNOLIA RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-2714
Practice Address - Country:US
Practice Address - Phone:662-212-3241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2149133VN1006X, 133VN1201X, 133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric