Provider Demographics
NPI:1992518278
Name:MEDLOCK, BRYNN
Entity type:Individual
Prefix:
First Name:BRYNN
Middle Name:
Last Name:MEDLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRYNN
Other - Middle Name:
Other - Last Name:STREPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:5730 CLOSEBURN RD APT H
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3039
Mailing Address - Country:US
Mailing Address - Phone:847-525-5425
Mailing Address - Fax:
Practice Address - Street 1:500 S MAIN ST STE 113
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3550
Practice Address - Country:US
Practice Address - Phone:704-893-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered