Individual
MS. TIFFANY LATESE STACKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
804 N PARKWAY, JACKSON, TN 38305-3058
(731) 423-3020
Mailing address
39 BROOKSIE DR, 589 EAST COLLEGE ST, JACKSON, TN 38305-3621
(731) 660-5611
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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