Provider Demographics
NPI:1043835325
Name:BACCHERINI, RHONDA MICHELLE (RD LD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:MICHELLE
Last Name:BACCHERINI
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12517 AUTUMN LEAVES TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-1139
Mailing Address - Country:US
Mailing Address - Phone:817-705-6017
Mailing Address - Fax:
Practice Address - Street 1:4420 HERITAGE TRACE PKWY STE 312
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8904
Practice Address - Country:US
Practice Address - Phone:817-993-6516
Practice Address - Fax:817-562-4467
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06398133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal