Provider Demographics
NPI:1285374793
Name:CARLSON, JULIA (RD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 17TH AVE S STE 10
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2219
Mailing Address - Country:US
Mailing Address - Phone:816-719-4799
Mailing Address - Fax:
Practice Address - Street 1:1018 17TH AVE S STE 10
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2219
Practice Address - Country:US
Practice Address - Phone:816-719-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4117133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered