Holly Marie Bundrant, PH.D., R.D., L.D.N.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LDN0000001650 Issued in TN

Practice address

225 N. Willow Ave.
Willow Ave. Professional Complex
Cookeville, TN 38501

Phone

(931) 528-1617

Fax

(931) 528-1617

NPI assigned

Mar 23, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316044800000",
    "number": "1174640494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2087 SHIPLEY SCHOOL RD",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385017722",
            "telephone_number": "931-528-1617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N. WILLOW AVE.",
            "address_2": "WILLOW AVE. PROFESSIONAL COMPLEX",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "38501",
            "telephone_number": "931-528-1617",
            "fax_number": "931-528-1617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNDRANT",
        "first_name": "HOLLY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PH.D., R.D., L.D.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2011-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TN",
            "license": "LDN0000001650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Registered Dietitian in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.