Provider Demographics
NPI:1194428235
Name:KOEHLER, JOANNA (RDN)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:KOEHLER
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 1:810 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3100
Mailing Address - Country:US
Mailing Address - Phone:573-837-8763
Mailing Address - Fax:
Practice Address - Street 1:810 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3100
Practice Address - Country:US
Practice Address - Phone:573-837-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000003845133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered