Provider Demographics
NPI:1699967471
Name:PENNINGTON, TAMMY BRADFORD (RD, CSR, LDN)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:BRADFORD
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:RD, CSR, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 COMANCHE TRL
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8105
Mailing Address - Country:US
Mailing Address - Phone:318-396-9293
Mailing Address - Fax:
Practice Address - Street 1:711 WOOD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7549
Practice Address - Country:US
Practice Address - Phone:318-323-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA578133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered