Basic Information
| Provider Information | |||||||||
| NPI: | 1699733345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | KAYE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 580 EBENEZER LOOP | ||||||||
| Address2: | |||||||||
| City: | CHUCKEY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376415605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232573085 | ||||||||
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| Practice Location | |||||||||
| Address1: | SIDNEY/LAMONT ST | ||||||||
| Address2: | NUTRITION AND FOOD SERVICE (120) | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129261171 | ||||||||
| FaxNumber: | 4239793402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 11/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | LDN0000000656 | TN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133VN1004X | LDN0000000656 | TN | N | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Pediatric |
No ID Information.