Individual
LEANNE SIMPSON MONTGOMERY
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
804 N PARKWAY, JACKSON, TN 38305-3058
(731) 423-3020
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871676593
PRACTICE NPI NUMBER
TN
05
—
4448133
—
TN
01
—
626000729
EMPLOYERS TAX ID
TN
Enumeration date
12/15/2008
Last updated
12/15/2008
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