Provider Demographics
NPI:1093421356
Name:GILES, REBEKAH ABIGAIL (RDN)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ABIGAIL
Last Name:GILES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 ENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3723
Mailing Address - Country:US
Mailing Address - Phone:903-530-7756
Mailing Address - Fax:
Practice Address - Street 1:824 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3723
Practice Address - Country:US
Practice Address - Phone:903-530-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86174238133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered