Provider Demographics
NPI:1093300857
Name:GENTRY, RACHAEL (RDN)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:LOMELI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6813 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3745
Mailing Address - Country:US
Mailing Address - Phone:806-777-4631
Mailing Address - Fax:
Practice Address - Street 1:5307 W LOOP 289 STE 106
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-1680
Practice Address - Country:US
Practice Address - Phone:888-422-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85171133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered