Provider Demographics
NPI:1225734866
Name:HART, LILY CLAIRE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:CLAIRE
Last Name:HART
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 N STEMMONS FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-2277
Mailing Address - Country:US
Mailing Address - Phone:469-488-5121
Mailing Address - Fax:
Practice Address - Street 1:2777 N STEMMONS FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2277
Practice Address - Country:US
Practice Address - Phone:469-488-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87267133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT87267OtherLICENSED DIETITIAN
86132923OtherREGISTERED DIETITIAN