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Contact Information

CASEY PROVO, MS, RDN, LDN
1689 NONCONNAH BLVD.
MEMPHIS, TN38132
 Phone: 901-523-8990
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
Indicates primary specialty

NPI Profile & details for CASEY PROVO · (Female)

NPI # 1386163707
Status Active
Credentials MS, RDN, LDN
Entity Individual
Enumeration date 09/18/2017
Last updated 03/17/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • TN License # 3200
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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