Provider Demographics
NPI:1588746978
Name:GILLENWATER, CAROLYN PATTERSON (RD,CNSD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:PATTERSON
Last Name:GILLENWATER
Suffix:
Gender:F
Credentials:RD,CNSD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:MARIE
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CNSD
Mailing Address - Street 1:175 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-3856
Mailing Address - Country:US
Mailing Address - Phone:423-753-7211
Mailing Address - Fax:
Practice Address - Street 1:JAMES H. QUILLEN/VAMC
Practice Address - Street 2:CORNER OF SIDNEY AND LAMONT
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-979-2928
Practice Address - Fax:423-979-3402
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372037133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered