Provider Demographics
NPI:1396562344
Name:CARPENTER, ANDREA KATHERINE (MS, RD, CSP, LD, CBS)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KATHERINE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MS, RD, CSP, LD, CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 TIMBERLINKS DR
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-1945
Mailing Address - Country:US
Mailing Address - Phone:334-740-4500
Mailing Address - Fax:
Practice Address - Street 1:396 TIMBERLINKS DR
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-1945
Practice Address - Country:US
Practice Address - Phone:334-740-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4415133V00000X, 133VN1401X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1401XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric Critical Care