Provider Demographics
NPI:1437019007
Name:TATE, CIERRA NICOLE (MDA, RDN, CD)
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:NICOLE
Last Name:TATE
Suffix:
Gender:F
Credentials:MDA, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 E 2620 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4106
Mailing Address - Country:US
Mailing Address - Phone:385-313-1455
Mailing Address - Fax:
Practice Address - Street 1:1175 E 2620 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4106
Practice Address - Country:US
Practice Address - Phone:385-313-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14253788-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered