Provider Demographics
NPI:1699733345
Name:GILBERT, SANDRA KAYE (RD)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAYE
Last Name:GILBERT
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 1:580 EBENEZER LOOP
Mailing Address - Street 2:
Mailing Address - City:CHUCKEY
Mailing Address - State:TN
Mailing Address - Zip Code:37641-5605
Mailing Address - Country:US
Mailing Address - Phone:423-257-3085
Mailing Address - Fax:
Practice Address - Street 1:SIDNEY/LAMONT ST
Practice Address - Street 2:NUTRITION AND FOOD SERVICE (120)
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:412-926-1171
Practice Address - Fax:423-979-3402
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000656133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric