Provider Demographics
NPI:1265025365
Name:FERNANDEZ, PRISCILLA (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LD
Mailing Address - Street 1:4527 VIA SAN ANTONIO
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-3550
Mailing Address - Country:US
Mailing Address - Phone:972-464-8565
Mailing Address - Fax:
Practice Address - Street 1:5200 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7709
Practice Address - Country:US
Practice Address - Phone:214-590-0153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX811434133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered