Provider Demographics
NPI:1235417155
Name:PITCOCK, JANA (RD, LD)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:PITCOCK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 QUAIL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1941
Mailing Address - Country:US
Mailing Address - Phone:407-399-5324
Mailing Address - Fax:
Practice Address - Street 1:5601 WARREN PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4069
Practice Address - Country:US
Practice Address - Phone:214-407-5397
Practice Address - Fax:214-407-5017
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81239133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered