Provider Demographics
NPI:1376911651
Name:HEINEN, RACHEL D (RDN, LD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:D
Last Name:HEINEN
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:D
Other - Last Name:HEINEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:8112 BROKEN ARROW RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1291
Mailing Address - Country:US
Mailing Address - Phone:817-793-0115
Mailing Address - Fax:
Practice Address - Street 1:8112 BROKEN ARROW RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1291
Practice Address - Country:US
Practice Address - Phone:817-793-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83490133NN1002X, 133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic