Individual
CASEY PROVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, LDN
Contact information
Practice address
1689 NONCONNAH BLVD., MEMPHIS, TN 38132
(901) 523-8990
Mailing address
1156 WEST NATCHEZ POINT, #72, MEMPHIS, TN 38103
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
3200
TN
Other
Enumeration date
09/18/2017
Last updated
03/17/2018
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