Provider Demographics
NPI:1144702069
Name:WILSON, ANDREA CLONINGER (RDN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:CLONINGER
Last Name:WILSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MRS
Other - First Name:ANDER
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN
Mailing Address - Street 1:2002 EASTLAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-1705
Mailing Address - Country:US
Mailing Address - Phone:704-307-8508
Mailing Address - Fax:
Practice Address - Street 1:2002 EASTLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-1705
Practice Address - Country:US
Practice Address - Phone:704-697-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered