Provider Demographics
NPI:1124679691
Name:RICHARDSON, TIFFANY DENISE (RD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DENISE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:TOWNSEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5905
Mailing Address - Country:US
Mailing Address - Phone:901-842-3160
Mailing Address - Fax:901-842-2360
Practice Address - Street 1:969 FRAYSER BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-5977
Practice Address - Country:US
Practice Address - Phone:901-842-3162
Practice Address - Fax:901-842-2362
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2648133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered