Provider Demographics
NPI:1124572524
Name:BURTON, HOLLY A (RD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:BURTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1140 CYPRESS STATION DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3045
Mailing Address - Country:US
Mailing Address - Phone:281-440-5300
Mailing Address - Fax:832-232-5591
Practice Address - Street 1:1140 CYPRESS STATION DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3045
Practice Address - Country:US
Practice Address - Phone:281-440-5300
Practice Address - Fax:832-232-5591
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXDT06084133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX535104YPNGMedicare PIN
TX535104YLOGMedicare PIN