Provider Demographics
NPI:1760239990
Name:HEAD, CAROL ANN (RDN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:HEAD
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3179 S WAYNOKA CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-3614
Mailing Address - Country:US
Mailing Address - Phone:731-616-3512
Mailing Address - Fax:
Practice Address - Street 1:6263 POPLAR AVE STE 605
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4724
Practice Address - Country:US
Practice Address - Phone:901-343-6146
Practice Address - Fax:901-328-1802
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4839133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered