Provider Demographics
NPI:1144378274
Name:BROWN, TERRY L (LD, RD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:LD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CANDLE MEADOW BLVD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-1429
Mailing Address - Country:US
Mailing Address - Phone:214-693-4766
Mailing Address - Fax:
Practice Address - Street 1:600 CANDLE MEADOW BLVD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-1429
Practice Address - Country:US
Practice Address - Phone:214-693-4766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06493133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
8D3875Medicare ID - Type Unspecified
TXQ20425Medicare UPIN