Provider Demographics
NPI:1124161971
Name:CAMPBELL, PATRICIA ANN (RD, LDN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BAYPATH DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7851
Mailing Address - Country:US
Mailing Address - Phone:865-481-0136
Mailing Address - Fax:
Practice Address - Street 1:710 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3143
Practice Address - Country:US
Practice Address - Phone:865-425-8759
Practice Address - Fax:865-457-4850
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000457133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered