Provider Demographics
NPI:1689416364
Name:POOLER, TABITHA (RDN)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:POOLER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SCHROER RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-2560
Mailing Address - Country:US
Mailing Address - Phone:918-361-7040
Mailing Address - Fax:
Practice Address - Street 1:128 SCHROER RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-2560
Practice Address - Country:US
Practice Address - Phone:918-361-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered