Provider Demographics
NPI:1326745514
Name:AXCELL, COURTNEY ANN (RDN, LD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:AXCELL
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5590 BRIGHT TIMBER LANDING DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4101
Mailing Address - Country:US
Mailing Address - Phone:328-379-9908
Mailing Address - Fax:
Practice Address - Street 1:5590 BRIGHT TIMBER LANDING DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4101
Practice Address - Country:US
Practice Address - Phone:328-379-9908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX896761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered