Provider Demographics
NPI:1235143553
Name:WASHBURN, VICKI STANPHILL (RD)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:STANPHILL
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:VICKI
Other - Middle Name:LEIGH
Other - Last Name:STANPHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TX
Mailing Address - Zip Code:75414-0513
Mailing Address - Country:US
Mailing Address - Phone:903-465-9329
Mailing Address - Fax:
Practice Address - Street 1:1209 E. 9TH ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4091
Practice Address - Country:US
Practice Address - Phone:903-583-6292
Practice Address - Fax:903-583-6565
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02113133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered