Provider Demographics
NPI:1033974217
Name:VERMILLION, ANDREA DENISE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DENISE
Last Name:VERMILLION
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 TIMOTHY DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2862
Mailing Address - Country:US
Mailing Address - Phone:214-240-7381
Mailing Address - Fax:
Practice Address - Street 1:856 TIMOTHY DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2862
Practice Address - Country:US
Practice Address - Phone:121-424-0738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
931809133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered