Provider Demographics
NPI:1275959793
Name:FUEL YOUR INTENSITY
Entity Type:Organization
Organization Name:FUEL YOUR INTENSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZIER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:972-935-6722
Mailing Address - Street 1:209 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-3755
Mailing Address - Country:US
Mailing Address - Phone:469-383-8334
Mailing Address - Fax:
Practice Address - Street 1:209 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3755
Practice Address - Country:US
Practice Address - Phone:469-383-8334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07454133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196126001Medicaid
TX1531043OtherCIGNA