Provider Demographics
NPI:1083207971
Name:RADIANT NUTRITION, LLC
Entity type:Organization
Organization Name:RADIANT NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RDN, LDN
Authorized Official - Phone:865-585-2677
Mailing Address - Street 1:11111 OAK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1924
Mailing Address - Country:US
Mailing Address - Phone:865-585-2677
Mailing Address - Fax:
Practice Address - Street 1:705 GATE LN STE 202
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3521
Practice Address - Country:US
Practice Address - Phone:865-585-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1801270319OtherNPI