Casey Provo, MS, RDN, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

3200 Issued in TN

Practice address

1689 Nonconnah Blvd.
Memphis, TN 38132

Phone

(901) 523-8990

NPI assigned

Sep 18, 2017

Sex

Female

Sole proprietor

No

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

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nuleeu Nutrition and Wellness, LLC

  dba Hampton Roads Nutrition

  • Registered Dietitian
  • Chesapeake, VA
  • NPI 1922576198

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1505692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1386163707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1156 WEST NATCHEZ POINT",
            "address_2": "#72",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1689 NONCONNAH BLVD.",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38132",
            "telephone_number": "901-523-8990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1030 Jefferson Ave.",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "38104",
            "country_code": "US",
            "telephone_number": "901-523-8990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVO",
        "first_name": "CASEY",
        "credential": "MS, RDN, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-18",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TN",
            "license": "3200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dallas Jordan Davis Provence, NP
• Providence EMS, LLC
• Providence Home and Community Living Service
• Provider Medical Supplies
• Katelyn Provine
• Dana Lee Prude, RN
• Sarah Montgomery Prudhon, RN
• Sarah Ellen Pruett
• Ticco Darrell Pruitt Sr.
• Morrell E Pruitte, BA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.