Provider Demographics
NPI:1124504386
Name:RICHARDS, CHEYENNE LOUISE (RDN, LD, MBA)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:LOUISE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:RDN, LD, MBA
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:LOUISE-BRYANT
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1007 JOHNNIE DODDS BLVD STE 117
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6123
Mailing Address - Country:US
Mailing Address - Phone:512-580-8354
Mailing Address - Fax:
Practice Address - Street 1:21 FAYE LN
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6626
Practice Address - Country:US
Practice Address - Phone:512-695-0769
Practice Address - Fax:843-972-8914
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1580133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered