Provider Demographics
NPI:1295821106
Name:HALL, JEANNETTE GAUSE (EDD, RD/LD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:GAUSE
Last Name:HALL
Suffix:
Gender:F
Credentials:EDD, RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 KIRBY DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:UT
Mailing Address - Zip Code:77098-3921
Mailing Address - Country:US
Mailing Address - Phone:713-798-7700
Mailing Address - Fax:713-798-7775
Practice Address - Street 1:3701 KIRBY DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3921
Practice Address - Country:US
Practice Address - Phone:713-798-7700
Practice Address - Fax:713-798-7775
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDTO1215133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J0801Medicare PIN