Provider Demographics
NPI:1114433943
Name:ROCHE, ABIGAIL CURRIE LENORE (RDN)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:CURRIE LENORE
Last Name:ROCHE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 N CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2301
Mailing Address - Country:US
Mailing Address - Phone:901-333-8249
Mailing Address - Fax:
Practice Address - Street 1:43 N CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2301
Practice Address - Country:US
Practice Address - Phone:901-333-8249
Practice Address - Fax:901-333-8255
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003253133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN86070450OtherCOMMISSION OF DIETETIC REGISTRATION
TN0000003253OtherLICENSE