Provider Demographics
NPI:1063927655
Name:BUCHANAN, TERYN COOK (RD)
Entity type:Individual
Prefix:MRS
First Name:TERYN
Middle Name:COOK
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 E QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2125
Mailing Address - Country:US
Mailing Address - Phone:559-824-8475
Mailing Address - Fax:
Practice Address - Street 1:5305 N FRESNO ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6845
Practice Address - Country:US
Practice Address - Phone:559-824-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1078139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty