Individual
KATY FUQUA FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1019 FLORIDA AVE, BRISTOL, TN 37620-4015
(615) 513-8795
Mailing address
1019 FLORIDA AVE, BRISTOL, TN 37620-4015
(615) 513-8795
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0000002180
TN
Other
Enumeration date
07/02/2021
Last updated
07/08/2024
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