Provider Demographics
NPI:1053146555
Name:PASS, SAMANTHA CHRISTINE (RDN, LDN)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:CHRISTINE
Last Name:PASS
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3179 SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3435
Mailing Address - Country:US
Mailing Address - Phone:901-483-5774
Mailing Address - Fax:
Practice Address - Street 1:6225 HUMPHREYS BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2373
Practice Address - Country:US
Practice Address - Phone:901-227-9023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4037133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered