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MRS. MISTY MULLINS CLACKUM RD CSP LDN NPI 1073944492


NPI Information

NPI: 1073944492
Provider Name: MRS. MISTY MULLINS CLACKUM, RD, CSP, LDN
Classification: Dietitian, Registered - 133VN1004X
Entity Type: Individual

Specialization: Nutrition, Pediatric

Address:
1208 SHERWOOD PARK DR NE STE A
GAINESVILLE, GA
ZIP 30501
Phone: (423) 774-4690
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MRS. Misty Mullins Clackum, RD, CSP, LDN is a nutrition and pediatric dietitian registered in Gainesville, GA. The provider is an individual who is a Board Certified Specialist in Pediatric Nutrition and applies evidence-based nutrition knowledge in providing medical nutrition therapy for pediatric patients. Specialists work directly with healthy and/or ill children (newborn up to 21 years of age) as well as children with special health care needs in a variety of settings (hospitals, community-based and/or family-centered programs, education programs, home, etc.), OR indirectly through management, care coordination, education, quality improvement, or research practice linked specifically to pediatric nutrition. MRS. Misty Mullins Clackum, RD, CSP, LDN NPI is 1073944492. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1208 SHERWOOD PARK DR NE STE A
GAINESVILLE, GA
ZIP 30501-445
Phone: (423) 774-4690

The enumeration date for this NPI number is 12/11/2013 and was last updated on 8/27/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1133V00000XDietitian, RegisteredLD002340GEORGIANo
2133VN1004XDietitian, RegisteredNutrition, PediatricLD002340GEORGIAYes
3133VN1004XDietitian, RegisteredNutrition, Pediatric1250TENNESSEENo
4133VN1401XDietitian, RegisteredNutrition, Pediatric Critical CareLD002340GEORGIANo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1Q038482MEDICAIDTENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.