Provider Demographics
NPI:1447887435
Name:MCDONALD, LEEANNE CHITTOM (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:LEEANNE
Middle Name:CHITTOM
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FACULTY OFFICE BLDG, 2ND FLOOR SUITE 249
Mailing Address - Street 2:49 N. DUNLAP
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105
Mailing Address - Country:US
Mailing Address - Phone:901-287-5581
Mailing Address - Fax:
Practice Address - Street 1:ULPS SURGERY, 2ND FLOOR
Practice Address - Street 2:50 N. DUNLAP
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-287-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1201133VN1004X, 133VN1005X, 133VN1201X, 133VN1401X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133VN1401XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1201OtherTN LICESNURE