Provider Demographics
NPI:1538030549
Name:HINDS, SHANNON MARLAR (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARLAR
Last Name:HINDS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 COUNTY ROAD 790
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-7202
Mailing Address - Country:US
Mailing Address - Phone:662-664-3113
Mailing Address - Fax:
Practice Address - Street 1:22 COUNTY ROAD 790
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7202
Practice Address - Country:US
Practice Address - Phone:662-664-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS86084268133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered